Individual
ANYA COLOTHA SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
6444 FALCONWOOD DR, WENDELL, NC 27591-9653
(813) 351-9086
Mailing address
6444 FALCONWOOD DR, WENDELL, NC 27591-9653
(813) 351-9086
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2023128902
NC
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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