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NPI Code Detail

MEDICARE: SAMANTHA PABALAN APRN

MEDICARE:   SAMANTHA  PABALAN  APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAPRN11007872FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023636008
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA PABALAN APRN
Provider Business Mailing Address
First Line : 2103 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4511
Country : US
Telephone Number : 850-763-8000
Fax Number : 850-785-1122
Provider Business Practice Location Address
First Line : 2103 JENKS AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4511
Country : US
Telephone Number : 850-763-8000
Fax Number : 850-785-1122
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2020
Last Update Date : 01/25/2022

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Directions to “ SAMANTHA PABALAN APRN” Practice Location

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