Provider Demographics
NPI:1295377224
Name:PICKRELL, SAMANTHA RENE (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RENE
Last Name:PICKRELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 N CONGRESS AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-4212
Mailing Address - Country:US
Mailing Address - Phone:561-734-4535
Mailing Address - Fax:561-734-7530
Practice Address - Street 1:244 N CONGRESS AVE STE 2A
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-4212
Practice Address - Country:US
Practice Address - Phone:561-734-4535
Practice Address - Fax:561-734-7530
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9408685163W00000X
FL11004061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse