Provider Demographics
NPI:1285857516
Name:SUBLETTE, SAMANTHA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MICHELLE
Last Name:SUBLETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:399 9TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5820
Mailing Address - Country:US
Mailing Address - Phone:239-624-4200
Mailing Address - Fax:
Practice Address - Street 1:399 9TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5820
Practice Address - Country:US
Practice Address - Phone:239-624-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067207A207RC0000X, 207RC0001X
FLME139839207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201029980Medicaid
IN000000990787OtherANTHEM PIN
IN000000990787OtherANTHEM PIN
IN201029980Medicaid