Provider Demographics
NPI:1427897818
Name:GOLDEN, SAMANTHA RAYE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAYE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30600 SUNNYRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6153
Mailing Address - Country:US
Mailing Address - Phone:305-509-2633
Mailing Address - Fax:
Practice Address - Street 1:30600 SUNNYRIDGE CT
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6153
Practice Address - Country:US
Practice Address - Phone:305-509-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant