Provider Demographics
NPI:1942729090
Name:BLUE, SAMANTHA AVLA (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:AVLA
Last Name:BLUE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:A
Other - Last Name:BLUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:15415 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-5409
Mailing Address - Country:US
Mailing Address - Phone:850-588-3589
Mailing Address - Fax:
Practice Address - Street 1:15415 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-5409
Practice Address - Country:US
Practice Address - Phone:850-583-9747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14129300163WA2000X
FLAPRN9487688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator