Healthcare Provider Details

I. General information

NPI: 1619558905
Provider Name (Legal Business Name): SAMITRIA LATRICE BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 W LOWDER ST
MACCLENNY FL
32063-2638
US

IV. Provider business mailing address

4300 SW 13TH ST
GAINESVILLE FL
32608-4006
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-5615
  • Fax:
Mailing address:
  • Phone: 352-374-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9283205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: