MEDICARE: SAMANTHA LEE CROFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11020090	FL

General Provider Information

NPI Number	:	1669161113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LEE CROFT

Provider Business Mailing Address
First Line	:	2309 EAGLE TALON CIR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 SOUTHPARK CIR E
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5135
Country	:	US
Telephone Number	:	904-342-4941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	05/02/2023

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