Provider Demographics
NPI:1245822691
Name:MCBEAN, SAMANTHA TALICIA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TALICIA
Last Name:MCBEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 BELLA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2634
Mailing Address - Country:US
Mailing Address - Phone:954-290-4566
Mailing Address - Fax:
Practice Address - Street 1:1672 BELLA VISTA WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2634
Practice Address - Country:US
Practice Address - Phone:954-290-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL334545163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty