Provider Demographics
NPI:1639620578
Name:CHAPMAN, SAMANTHA KELLI
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KELLI
Last Name:CHAPMAN
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:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1431
Mailing Address - Country:US
Mailing Address - Phone:850-770-3290
Mailing Address - Fax:850-770-3295
Practice Address - Street 1:489 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404
Practice Address - Country:US
Practice Address - Phone:850-770-3290
Practice Address - Fax:850-770-3295
Is Sole Proprietor?:No
Enumeration Date:2016-10-15
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9335696163WE0003X
FLARNP9335696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency