# MS. SAMANTHA F FREDERICK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1124614631
- **Gender:** F
- **Credential:** NP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | RN203567 | GA | Yes |

## Other

- **Enumeration date:** 12/18/2020
- **Last updated:** 09/30/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003245264A | — | GA |
| 05 | — | 003245264B | — | GA |
| 01 | — | G24488A | MEDICARE PTAN | GA |