Provider Demographics
NPI:1386234839
Name:BOUIE, SAMANTHA HOPE (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:HOPE
Last Name:BOUIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11802 TEMPEST HARBOR LOOP
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3821
Mailing Address - Country:US
Mailing Address - Phone:941-676-3440
Mailing Address - Fax:941-208-1363
Practice Address - Street 1:11802 TEMPEST HARBOR LOOP
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3821
Practice Address - Country:US
Practice Address - Phone:941-676-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily