Provider Demographics
NPI:1134462278
Name:JAMES, SAMARIA S
Entity Type:Individual
Prefix:
First Name:SAMARIA
Middle Name:S
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMARIA
Other - Middle Name:S
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:104 TALLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:FL
Mailing Address - Zip Code:32189-2690
Mailing Address - Country:US
Mailing Address - Phone:386-559-3033
Mailing Address - Fax:
Practice Address - Street 1:104 TALLWOOD AVE
Practice Address - Street 2:
Practice Address - City:SATSUMA
Practice Address - State:FL
Practice Address - Zip Code:32189-2690
Practice Address - Country:US
Practice Address - Phone:386-559-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9376787314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility