Provider Demographics
NPI:1386129195
Name:PETERSON, SAMANTHA MICHELLE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MICHELLE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:MICHELLE
Other - Last Name:SIERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10023 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5643
Mailing Address - Country:US
Mailing Address - Phone:772-398-5339
Mailing Address - Fax:
Practice Address - Street 1:10023 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5643
Practice Address - Country:US
Practice Address - Phone:772-398-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9356995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily