Provider Demographics
NPI:1841693504
Name:SAMUELSON, RACHEL MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:SAMUELSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350G RACETRACK RD NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1699
Mailing Address - Country:US
Mailing Address - Phone:850-374-3125
Mailing Address - Fax:850-226-5544
Practice Address - Street 1:350G RACETRACK RD NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1699
Practice Address - Country:US
Practice Address - Phone:850-374-3125
Practice Address - Fax:850-226-5544
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108196363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical