Provider Demographics
NPI:1598171175
Name:LAWRENCE, SAMANTHA MARY (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:MARY
Last Name:LAWRENCE
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 1:2115 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8815
Mailing Address - Country:US
Mailing Address - Phone:727-526-9135
Mailing Address - Fax:727-526-4346
Practice Address - Street 1:2137 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3923
Practice Address - Country:US
Practice Address - Phone:727-526-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9296311363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012354100Medicaid