Provider Demographics
NPI:1538784046
Name:PARKER, SAMANTHA (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PARKER
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 1:8575 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:IVOR
Mailing Address - State:VA
Mailing Address - Zip Code:23866
Mailing Address - Country:US
Mailing Address - Phone:757-859-6161
Mailing Address - Fax:
Practice Address - Street 1:8575 IVOR ROAD
Practice Address - Street 2:
Practice Address - City:IVOR
Practice Address - State:VA
Practice Address - Zip Code:23866
Practice Address - Country:US
Practice Address - Phone:757-859-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001270005163W00000X
VA0024179454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse