Provider Demographics
NPI:1174005185
Name:MCDANIEL, SAMANTHA NICHOLE (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NICHOLE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 ELMS CENTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9844
Mailing Address - Country:US
Mailing Address - Phone:843-302-8840
Mailing Address - Fax:
Practice Address - Street 1:2550 ELMS CENTER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9844
Practice Address - Country:US
Practice Address - Phone:843-302-8840
Practice Address - Fax:843-818-2188
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24111363LF0000X
OHAPRN.CNP.023593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily