Provider Demographics
NPI:1083953152
Name:MARR, SAMANTHA J (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:MARR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:J
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7800 US HIGHWAY 98 WEST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550
Mailing Address - Country:US
Mailing Address - Phone:850-278-3000
Mailing Address - Fax:850-475-4781
Practice Address - Street 1:7800 US HIGHWAY 98 W # ER
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7228
Practice Address - Country:US
Practice Address - Phone:850-278-3510
Practice Address - Fax:850-475-4781
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107898363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0P4GOtherBCBS
FL0140269-00Medicaid
FLHX141YMedicare PIN