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General NPI Number Information
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NPI Number | 1023438512
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Entity Type | Individual
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Provider Name | SAMANTHA JEAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 2525 HARBOR BLVD SUITE 308
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 419-629-7777
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Fax | 941-629-8170
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Provider Business Mailing Address
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Address Line | 2525 HARBOR BLVD SUITE 308
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 419-629-7777
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Fax | 941-629-8170
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 336250
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME132410
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License Number State | FL
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