Provider Demographics
NPI:1891486858
Name:STREET, SAMANTHA GRACE (DOULA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:GRACE
Last Name:STREET
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2798 NW 27TH TER
Mailing Address - Street 2:
Mailing Address - City:LAKE PANASOFFKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33538-3924
Mailing Address - Country:US
Mailing Address - Phone:352-461-6857
Mailing Address - Fax:
Practice Address - Street 1:2798 NW 27TH TER
Practice Address - Street 2:
Practice Address - City:LAKE PANASOFFKEE
Practice Address - State:FL
Practice Address - Zip Code:33538-3924
Practice Address - Country:US
Practice Address - Phone:352-461-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula