Samantha Wahl, AGNP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

11038776 Issued in FL

Practice address

4001 Swift Rd.
Suite 2
Sarasota, FL 34231

Phone

(941) 350-8568

NPI assigned

Apr 11, 2025

Last updated

Apr 11, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sarasota Spine & Sport Chiropractic Clinic

  dba Sarasota Spine & Joint Integrated Medical

  • Sports Medicine (Internal Medicine) Physician
  • Sarasota, FL
  • NPI 1174861165
  Medicare reassignment NPD
• Sarasota Spine & Sport Chiropractic Clinic

  • Internal Medicine Physician
  • Bradenton, FL
  • NPI 1003330838
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744329600000",
    "number": "1821883661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22331",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342765331",
            "telephone_number": "941-914-2036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 SWIFT RD.",
            "address_2": "SUITE 2",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "34231",
            "telephone_number": "941-350-8568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHL",
        "first_name": "SAMANTHA",
        "name_prefix": "Ms.",
        "credential": "AGNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-11",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "FL",
            "license": "11038776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dru E Wagner, CRNA
• Jason Kane Wagner, M.D.
• Jennifer Wagner, LCSW
• Kevin Wagner, HAS, BC-HIS
• Marcus James Wagner, PTA
• Stephen Marshall Wahl, MD
• David Wakeland, D.O.
• Paula Leslie Wakeland, RPH
• Wal-Mart Stores East LP (Vision Center 30-1171)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-3066)

• Gerontology Nurse Practitioner in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Gerontology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.