Provider Demographics
NPI:1104354190
Name:SOKOL, SAMANTHA N (PAC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:N
Last Name:SOKOL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:N
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11511 CANTERWOOD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5813
Mailing Address - Country:US
Mailing Address - Phone:253-382-8150
Mailing Address - Fax:253-382-8155
Practice Address - Street 1:11511 CANTERWOOD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5813
Practice Address - Country:US
Practice Address - Phone:253-382-8150
Practice Address - Fax:253-382-8155
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60763659363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2086628Medicaid
WA8970052OtherMEDICAR PIN