Provider Demographics
NPI:1942708599
Name:SAMUEL, ANGELIQUE (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ANGELIQUE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8235 FIRETOWER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6559
Mailing Address - Country:US
Mailing Address - Phone:904-376-5018
Mailing Address - Fax:
Practice Address - Street 1:8235 FIRETOWER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6559
Practice Address - Country:US
Practice Address - Phone:904-376-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9350566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily