SAMANTHA ERICKSEN (NPI# 1679071773) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679071773 |
| Entity Type | Individual |
| Full Name | SAMANTHA ERICKSEN |
| Credential | PA-C |
| Practice Address |
11513 N Main St Jacksonville FL 32218-4002 |
| Mailing Address |
2675 Winkler Ave Fl 2floor Fort Myers FL 33901-9342 |
| Practice Telephone | 9047516200 |
| Practice Fax Number | 9047511600 |
| Mailing Telephone | 8778563774 |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2020-03-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | NCCPA | 1150959 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215422431 | Samantha Joy Ericksen | Technician, Other | 2814 Woodcliff Cir Se, Grand Rapids, MI 49506 | 2018-06-29 |
| Street Address |
11513 N MAIN ST |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32218-4002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538146048 | Patrick Deverell Bianchi | Specialist | 11513 N Main St, Jacksonville, FL 32218-4002 | 2005-12-27 |
| 1467944918 | Courtney Michelle Griffin | Physician Assistant | 11513 N Main St, Jacksonville, FL 32218-4002 | 2018-05-31 |
| 1184081465 | Elizabeth Breza | Nurse Practitioner | 11513 N Main St, Jacksonville, FL 32218 | 2016-01-18 |
| 1023419728 | Diana Medina | Physician Assistant | 11513 N Main St, Jacksonville, FL 32218-4002 | 2014-09-12 |
| 1710237276 | Elizabeth Keeler Marshall | Physician Assistant | 11513 N Main St, Jacksonville, FL 32218-4002 | 2012-09-12 |
| 1467718007 | Joan Helen Mccaulie | Internal Medicine | 11513 N Main St, Jacksonville, FL 32218-4002 | 2012-04-09 |
| 1235403221 | Baptist Cardiology, Inc. | Internal Medicine | 11513 N Main St, Jacksonville, FL 32218-4002 | 2012-03-08 |
| 1861506644 | Zhi J Yu | Family Medicine | 11513 N Main St, Jacksonville, FL 32218-4002 | 2006-08-18 |
| 1306861240 | Burton H. Mendel | Physician Assistant | 11513 N Main St, Jacksonville, FL 32218-4002 | 2006-07-13 |
| 1245255199 | Oceanway Medical Center, Inc. | Family Medicine | 11513 N Main St, Jacksonville, FL 32218-4002 | 2006-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629684170 | Damon Lamar Baker | Nurse Practitioner | 12533 Sampson Rd, Jacksonville, Fl, FL 32218 | 2020-09-21 |
| 1578199303 | First Coast Health Ventures, LLC | Skilled Nursing Facility | 15480 Max Leggett Parkway, Jacksonville, FL 32218 | 2020-03-12 |
| 1932679594 | Alaina Rachelle Stanley | Counselor | 11683 Spring Board Dr, Jacksonville, FL 32218 | 2018-11-27 |
| 1508345133 | War Cry Ministry Inc | Counselor | 435 Eric Ave, Jacksonville, FL 32218 | 2018-08-14 |
| 1285111484 | St Vincent's Full Service Urgent Care, LLC | Clinic/Center | 15510 Max Leggett Parkway, Ste A, Jacksonville, FL 32218 | 2018-07-20 |
| 1427544501 | Derrick Roberts | Behavioral Analyst | 11302 Forestdale Rd, Jacksonville, FL 32218 | 2018-07-02 |
| 1215420229 | Companion & Compassion LLC | Home Health | 856 Poydras Ln W, Jacksonville, FL 32218 | 2018-06-13 |
| 1952894784 | Michael Alexander Aaro | Dentist | 1840 Dunn Ave Ste 3, Jacksonville, FL 32218 | 2018-06-06 |
| 1235629445 | Melissa C Moree | Counselor | 13453 Main St. North, Suite 104, Jacksonville, FL 32218 | 2018-05-14 |
| 1861900896 | Sheila Nowlin | Physical Therapist | 1034 Dunn Ave, Jacksonville, FL 32218 | 2018-01-11 |
| Find all providers in zip 32218 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831799527 | Emily Vander Zee | Physician Assistant | 6680 Bennett Creek Dr Apt 213, Jacksonville, FL 32216-0018 | 2020-10-30 |
| 1245830314 | Jonathan V Korah | Physician Assistant | 6650 Corporate Center Pkwy Apt 1108, Jacksonville, FL 32216-8725 | 2020-10-28 |
| 1255931473 | Rachel Gavrielle Stahly | Physician Assistant | 11438 Emuness Rd, Jacksonville, FL 32218-4050 | 2020-10-27 |
| 1760099071 | Laura Alexandra Ramos-heckman | Physician Assistant | 2014 Capistrano Dr, Jacksonville, FL 32224-3091 | 2020-09-30 |
| 1184230583 | Julian Clouse | Physician Assistant | 9803 Creekfront Rd Apt 307, Jacksonville, FL 32256-8449 | 2020-09-21 |
| 1962016717 | Stephanie Benton Gentry | Physician Assistant | 3179 Shadow Creek Rd, Jacksonville, FL 32226-2386 | 2020-08-31 |
| 1629689435 | Monarch Mental Health Association | Physician Assistant | 5393 Roosevelt Blvd Ste 8, Jacksonville, FL 32210-8424 | 2020-08-14 |
| 1235749425 | Nicole Lhommedieu | Physician Assistant | 3850 Marnie Pl, Jacksonville, FL 32223-3541 | 2020-08-03 |
| 1861002123 | Naw-am Acio Daniels | Physician Assistant | 7467 Volley Dr N, Jacksonville, FL 32277-9368 | 2020-08-03 |
| 1750906640 | Veronica Adriana Dediego | Physician Assistant | 915 W Monroe St Ste 300, Jacksonville, FL 32204-1177 | 2020-06-16 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32218 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.