Provider Demographics
NPI:1407374077
Name:LANCE, SAMANTHA (ARNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LANCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12213 SMOKE RIDGE CIR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3635
Mailing Address - Country:US
Mailing Address - Phone:904-238-0156
Mailing Address - Fax:
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 615
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-398-9334
Practice Address - Fax:904-398-9336
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9381212163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse