Provider Demographics
NPI:1467891366
Name:GUY, SAMANTHA LUANNE (PA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LUANNE
Last Name:GUY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BODIN CIR
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:707-423-5439
Mailing Address - Fax:707-423-5426
Practice Address - Street 1:101 BODIN CIRCLE
Practice Address - Street 2:ATTN: CREDENTIALS OFFICE
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1800
Practice Address - Country:US
Practice Address - Phone:707-423-7295
Practice Address - Fax:707-423-5426
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9112452363A00000X
CA61595363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant