Healthcare Provider Details

I. General information

NPI: 1639620578
Provider Name (Legal Business Name): SAMANTHA KELLI CHAPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2016
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 N TYNDALL PKWY
PANAMA CITY FL
32404
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-1431
US

V. Phone/Fax

Practice location:
  • Phone: 850-770-3290
  • Fax: 850-770-3295
Mailing address:
  • Phone: 850-770-3290
  • Fax: 850-770-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9335696
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9335696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: