Provider Demographics
NPI:1700334612
Name:SUGARMAN, SAMANTHA (ARNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SUGARMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 EAGLES WALK
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7340
Mailing Address - Country:US
Mailing Address - Phone:770-914-1808
Mailing Address - Fax:770-914-6828
Practice Address - Street 1:6229 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5025
Practice Address - Country:US
Practice Address - Phone:727-623-9913
Practice Address - Fax:727-803-6852
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN285120363LF0000X
FLARNP9432866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily