Provider Demographics
NPI:1679350987
Name:PETERS, SAMANTHA CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CHRISTINE
Last Name:PETERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SKIPPERLING LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7060
Mailing Address - Country:US
Mailing Address - Phone:937-238-3995
Mailing Address - Fax:
Practice Address - Street 1:5401 NETHERBY LN STE 1202
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7365
Practice Address - Country:US
Practice Address - Phone:843-872-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant