| Samantha A. Wagner, Phd, Llc | |
|
20747 Sterlington Dr Land O Lakes FL 34638-4317 | |
| (813) 815-2947 | |
| Not Available |
| Full Name | Samantha A. Wagner, Phd, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 20747 Sterlington Dr, Land O Lakes, Florida |
| Authorized Official Name and Position | Samantha Ann Wagner (PSYCHOLOGIST) |
| Authorized Official Contact | 8138152947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samantha A. Wagner, Phd, Llc 20747 Sterlington Dr Land O Lakes FL 34638-4317 Ph: (813) 815-2947 | Samantha A. Wagner, Phd, Llc 20747 Sterlington Dr Land O Lakes FL 34638-4317 Ph: (813) 815-2947 |
| NPI Number | 1548045131 |
|---|---|
| Provider Enumeration Date | 08/30/2023 |
| Last Update Date | 08/30/2023 |
| Certification Date | 08/30/2023 |
| Medicare PECOS PAC ID | 7012363559 |
|---|---|
| Medicare Enrollment ID | O20231019002509 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548045131 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Samantha Ann Wagner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457078735 PECOS PAC ID: 4284007691 Enrollment ID: I20230306002937 |
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