Provider Demographics
NPI:1518672526
Name:KING, SAMANTHA L (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1300 MIICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5054
Mailing Address - Country:US
Mailing Address - Phone:850-431-0911
Mailing Address - Fax:850-431-0779
Practice Address - Street 1:1300 MIICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-0911
Practice Address - Fax:850-431-0779
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant