Healthcare Provider Details

I. General information

NPI: 1194651299
Provider Name (Legal Business Name): SAMANTHA COPELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8331 N DAVIS HWY
PENSACOLA FL
32514-6094
US

IV. Provider business mailing address

8331 N DAVIS HWY
PENSACOLA FL
32514-6094
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-4700
  • Fax: 850-505-4711
Mailing address:
  • Phone: 850-505-4700
  • Fax: 850-505-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11048440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: