Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 18811 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 684081 | TX |
NPI | 1053369439 |
---|---|
Provider Name | Elizabeth A Samuels |
First Address | Jacksonville, FL 32223-2640 |
Second Address | Lemon Grove, CA 91945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 20/11/2018 |