Healthcare Provider Details

I. General information

NPI: 1962339226
Provider Name (Legal Business Name): SAMANTHA HEATON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 E HIGHWAY 390 APT 10206
PANAMA CITY FL
32404-9826
US

IV. Provider business mailing address

4201 E HIGHWAY 390 APT 10206
PANAMA CITY FL
32404-9826
US

V. Phone/Fax

Practice location:
  • Phone: 850-324-7400
  • Fax:
Mailing address:
  • Phone: 850-324-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11047427
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRNP339373
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: