Provider Demographics
NPI:1730760778
Name:JONES, SAMANTHA DANICE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DANICE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6813 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32466-2137
Mailing Address - Country:US
Mailing Address - Phone:850-630-2263
Mailing Address - Fax:
Practice Address - Street 1:3700 34TH ST STE 100D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6606
Practice Address - Country:US
Practice Address - Phone:850-630-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL21000140406253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care