Provider Demographics
NPI:1982440947
Name:PHILLIPS, MYA SAMANTHA (RMA, HHA)
Entity type:Individual
Prefix:
First Name:MYA
Middle Name:SAMANTHA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RMA, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 NESMITH RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33567-3859
Mailing Address - Country:US
Mailing Address - Phone:813-750-4725
Mailing Address - Fax:
Practice Address - Street 1:5113 NESMITH RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33567-3859
Practice Address - Country:US
Practice Address - Phone:813-750-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2021336P374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty