Provider Demographics
NPI:1689014862
Name:PALMER, SAMUEL COPELAND IV (CNP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:COPELAND
Last Name:PALMER
Suffix:IV
Gender:M
Credentials:CNP
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Mailing Address - Street 1:1220 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8852
Mailing Address - Country:US
Mailing Address - Phone:904-490-8700
Mailing Address - Fax:904-490-9810
Practice Address - Street 1:1220 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8852
Practice Address - Country:US
Practice Address - Phone:904-490-8700
Practice Address - Fax:904-490-9810
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2022-12-01
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Provider Licenses
StateLicense IDTaxonomies
PASP017792363LA2200X
DELP-0000214363LA2200X
NY308308363LA2200X
FL9485401363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health