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General NPI Number Information
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NPI Number | 1669964961
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Entity Type | Individual
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Provider Name | SAMANTHA DESTINEY HOLCOMB DO
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Gender | Female
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 2020 26TH AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-7753
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Country | US
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Telephone | 941-782-4344
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Fax |
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Provider Business Mailing Address
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Address Line | 9923 PATTERSON WAY
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City | PARRISH
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State | FL
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Zip | 34219-1175
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Country | US
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Telephone | 941-405-7394
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | UO9586
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License Number State | FL
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