Provider Demographics
NPI:1528811163
Name:FINE, SAMANTHA JANE (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:FINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HALSTON CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2029
Mailing Address - Country:US
Mailing Address - Phone:410-608-9922
Mailing Address - Fax:
Practice Address - Street 1:6501 BALTIMORE NATIONAL PIKE STE D
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3923
Practice Address - Country:US
Practice Address - Phone:667-234-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC006404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily