Provider Demographics
NPI:1073019576
Name:ERB, SAMANTHA ADAIR (DO)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ADAIR
Last Name:ERB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 38TH AVE N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1263
Mailing Address - Country:US
Mailing Address - Phone:727-345-1332
Mailing Address - Fax:727-345-3200
Practice Address - Street 1:7655 38TH AVE N STE 101
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1263
Practice Address - Country:US
Practice Address - Phone:727-345-1332
Practice Address - Fax:727-345-3200
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS17511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110847200Medicaid
FLFE0176912OtherDEA