MEDICARE: SAMANTHA ZINGARELLI

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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1649122722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ZINGARELLI

Provider Business Mailing Address
First Line	:	4805 KALMIA CIR
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-6202
Country	:	US
Telephone Number	:	904-652-7982
Fax Number	:

Provider Business Practice Location Address
First Line	:	4805 KALMIA CIR
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-6202
Country	:	US
Telephone Number	:	904-652-7982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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