Healthcare Provider Details

I. General information

NPI: 1982152377
Provider Name (Legal Business Name): SAMANTHA NOAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NW 64TH TER SUITE A
GAINESVILLE FL
32605-4243
US

IV. Provider business mailing address

1121 NW 64TH TER SUITE A
GAINESVILLE FL
32605-4243
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3583
  • Fax: 352-331-3669
Mailing address:
  • Phone: 352-331-3583
  • Fax: 352-331-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3405522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: