Provider Demographics
NPI:1760144547
Name:WALTERS, SAMANTHA DARLENE (PA-C)
Entity Type:Individual
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First Name:SAMANTHA
Middle Name:DARLENE
Last Name:WALTERS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:242 AQUARIUS CIR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1540
Mailing Address - Country:US
Mailing Address - Phone:850-803-3662
Mailing Address - Fax:
Practice Address - Street 1:915 W MONROE ST STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1177
Practice Address - Country:US
Practice Address - Phone:904-384-2240
Practice Address - Fax:904-486-2314
Is Sole Proprietor?:No
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant