Provider Demographics
NPI:1841673100
Name:DENBOER, SAMANTHA (MS, PSYD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:DENBOER
Suffix:
Gender:F
Credentials:MS, PSYD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KOEPPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PSYD
Mailing Address - Street 1:1555 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1734
Mailing Address - Country:US
Mailing Address - Phone:239-533-9860
Mailing Address - Fax:239-533-9860
Practice Address - Street 1:1555 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1734
Practice Address - Country:US
Practice Address - Phone:239-533-9860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9315103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIH633ZMedicare PIN