Provider Demographics
NPI:1720314313
Name:SAMPSON, NANCY PEARCE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:PEARCE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:PAIGE
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5048 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-8901
Mailing Address - Country:US
Mailing Address - Phone:850-934-6295
Mailing Address - Fax:850-934-6242
Practice Address - Street 1:5048 LANTANA DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-8901
Practice Address - Country:US
Practice Address - Phone:850-934-6295
Practice Address - Fax:850-934-6242
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLMHC3236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health