1841888773 NPI number — SAMANTHA L GULLETT ATC, LAT, OTC, PA-C

NPI Number: 1841888773
Health Care Provider/Practitioner: SAMANTHA L GULLETT ATC, LAT, OTC, PA-C

NPI Number : 1841888773 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1841888773",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GULLETT",
    "FirstName": "SAMANTHA",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC, LAT, OTC, PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "160 WILLOW CREEK CV",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LONGWOOD",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32750-3820",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-830-2776",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4560 LANTANA RD STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE WORTH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33463-6998",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-967-4400",
    "PracticeLocationAddressFaxNumber": "844-959-0419",
    "EnumerationDate": "01/06/2021",
    "LastUpdateDate": "09/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "AL5559",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "246ZX2200X",
          "TaxonomyName": "Orthopedic Assistant",
          "LicenseNumber": "201116",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}