Healthcare Provider Details

I. General information

NPI: 1467227470
Provider Name (Legal Business Name): SAMANTHA WOMBOUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 36TH ST
VERO BEACH FL
32960-4898
US

IV. Provider business mailing address

933 LEVITT PKWY
ROCKLEDGE FL
32955-4039
US

V. Phone/Fax

Practice location:
  • Phone: 772-564-8383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: