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NPI Code Detail

MEDICARE: SAMANTHA TARANTINO KENNEDY MD

MEDICARE: SAMANTHA TARANTINO KENNEDY MD
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
1208000000XPediatrics PhysicianME155385FL

General Provider Information

NPI Number : 1689232506
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA TARANTINO KENNEDY MD
Provider Business Mailing Address
First Line : 800 PRUDENTIAL DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8202
Country : US
Telephone Number : 904-202-8000
Fax Number :
Provider Business Practice Location Address
First Line : 800 PRUDENTIAL DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8202
Country : US
Telephone Number : 904-202-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2019
Last Update Date : 03/13/2026

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