Provider Demographics
NPI:1043053127
Name:PCOLA, SAMANTHA J (PA-C)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:J
Last Name:PCOLA
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:FAISON
Mailing Address - State:NC
Mailing Address - Zip Code:28341-0187
Mailing Address - Country:US
Mailing Address - Phone:910-267-2042
Mailing Address - Fax:855-996-9090
Practice Address - Street 1:103 COTTON CREEK RD
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:NC
Practice Address - Zip Code:27356-7954
Practice Address - Country:US
Practice Address - Phone:910-492-4646
Practice Address - Fax:910-226-7432
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-14544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant