Wagner, Samantha Nicole

Wagner, Samantha Nicole is an individual health care provider with primary practice located at 1563 Kingsley Ave Ste 103 , Orange Park FL 32073-4503. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as her primary health care specialty. Wagner, Samantha Nicole can be contacted via phone (904) 602-9740.

Contact Information

Primary practice address
1563 Kingsley Ave Ste 103 Orange Park FL 32073-4503
Phone: (904) 602-9740
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X

Profile Details

NPI number 1083245781
LBN Legal business name Wagner, Samantha Nicole
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 31st, 2020
Last updated Jan 31st, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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