Healthcare Provider Details

I. General information

NPI: 1295283737
Provider Name (Legal Business Name): SAMANTHA WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 EVENINGWOOD CT
TRINITY FL
34655-5027
US

IV. Provider business mailing address

10740 EVENINGWOOD CT
TRINITY FL
34655-5027
US

V. Phone/Fax

Practice location:
  • Phone: 727-710-2124
  • Fax: 727-845-8425
Mailing address:
  • Phone: 727-710-2124
  • Fax: 727-845-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number230217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: