Provider Demographics
NPI:1871616003
Name:CRIBBETT, SAMANTHA (NP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:CRIBBETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2673
Mailing Address - Country:US
Mailing Address - Phone:090-426-2721
Mailing Address - Fax:
Practice Address - Street 1:12311 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2673
Practice Address - Country:US
Practice Address - Phone:904-262-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN189729363L00000X
FLARNP9235588363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner