Individual
SAMANTHA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10948 RALEY CREEK DR S, JACKSONVILLE, FL 32225-2324
(904) 888-2928
Mailing address
10948 RALEY CREEK DR S, JACKSONVILLE, FL 32225-2324
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
E3044177
TX
Other
Enumeration date
09/19/2014
Last updated
09/19/2014
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