Provider Demographics
NPI:1942920343
Name:HALL, SAMANTHA KAYE (FNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAYE
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9792
Mailing Address - Country:US
Mailing Address - Phone:352-527-6888
Mailing Address - Fax:352-527-8818
Practice Address - Street 1:1990 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9792
Practice Address - Country:US
Practice Address - Phone:352-527-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905425363L00000X
FL11029447363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner