Provider Demographics
NPI:1437934346
Name:KNOX, SAMANTHA SHORES
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:SHORES
Last Name:KNOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 HARVEST CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4158
Mailing Address - Country:US
Mailing Address - Phone:321-266-2598
Mailing Address - Fax:
Practice Address - Street 1:6549 N WICKHAM RD STE 103E
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2041
Practice Address - Country:US
Practice Address - Phone:321-364-2822
Practice Address - Fax:877-684-0805
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028358363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily