Provider Demographics
NPI:1801480041
Name:PECUNES, SAMANTHA JO (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:PECUNES
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:WISNOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:9313 MEDICAL PLAZA DR STE 305
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9197
Mailing Address - Country:US
Mailing Address - Phone:843-863-5600
Mailing Address - Fax:843-553-2123
Practice Address - Street 1:9313 MEDICAL PLAZA DR STE 305
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9197
Practice Address - Country:US
Practice Address - Phone:843-863-5600
Practice Address - Fax:843-553-2123
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25234363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily