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General NPI Number Information
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NPI Number | 1083953152
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Entity Type | Individual
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Provider Name | SAMANTHA J MARR PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7800 US HIGHWAY 98 W # ER
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-7228
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Country | US
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Telephone | 850-278-3510
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Fax | 850-475-4781
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Provider Business Mailing Address
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Address Line | 7800 US HIGHWAY 98 WEST
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550
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Country | US
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Telephone | 850-278-3000
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Fax | 850-475-4781
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9107898
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License Number State | FL
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