Provider Demographics
NPI:1033503438
Name:REYNOLDS, SAMANTHA D (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:D
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HEALTH PARK BLVD STE 3002
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3703
Mailing Address - Country:US
Mailing Address - Phone:904-819-1500
Mailing Address - Fax:904-810-1023
Practice Address - Street 1:300 HEALTH PARK BLVD STE 3002
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3703
Practice Address - Country:US
Practice Address - Phone:904-819-1500
Practice Address - Fax:904-810-1023
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9233956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLID313ZOtherMEDICARE
FL014640900Medicaid