Provider Demographics
NPI:1851884811
Name:LAQUA, SAMANTHA MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MARY ELIZABETH
Last Name:LAQUA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:26827 FOGGY CREEK RD BLDG 6
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6768
Mailing Address - Country:US
Mailing Address - Phone:813-973-7774
Mailing Address - Fax:813-973-8882
Practice Address - Street 1:26827 FOGGY CREEK RD BLDG 6
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6768
Practice Address - Country:US
Practice Address - Phone:813-973-7774
Practice Address - Fax:813-973-8882
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN26766207Q00000X
FLME142301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine