Provider Demographics
NPI:1265870653
Name:MIKALS, SAMANTHA JEANNETTE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JEANNETTE
Last Name:MIKALS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5011 GATE PARKWAY
Mailing Address - Street 2:BLDG 100 STE 100 #1064
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-925-1951
Mailing Address - Fax:904-506-0187
Practice Address - Street 1:5011 GATE PARKWAY
Practice Address - Street 2:BLDG 100 STE 100 #1064
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-925-1951
Practice Address - Fax:904-506-0187
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2025-07-22
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Provider Licenses
StateLicense IDTaxonomies
VA0101256678207Y00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology