Provider Demographics
NPI:1619594124
Name:SAMPSON, ANDRIECE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ANDRIECE
Middle Name:
Last Name:SAMPSON
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 1:1400 VILLAGE SQUARE BLVD # 3-81600
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1250
Mailing Address - Country:US
Mailing Address - Phone:805-612-4567
Mailing Address - Fax:
Practice Address - Street 1:1400 VILLAGE SQUARE BLVD # 3-81600
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1250
Practice Address - Country:US
Practice Address - Phone:805-612-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV831410363LF0000X
CA95026377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily