Provider Demographics
NPI:1760452502
Name:KAPNICK, SAMUEL JASON (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JASON
Last Name:KAPNICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4205 BELFORT RD
Mailing Address - Street 2:STE 4015
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6014
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:1545 AIRPORT BLVD
Practice Address - Street 2:STE 2000
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8615
Practice Address - Country:US
Practice Address - Phone:561-622-3810
Practice Address - Fax:561-743-6354
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-12-01
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Provider Licenses
StateLicense IDTaxonomies
FLME49489207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA57233Medicare UPIN