Provider Demographics
NPI:1730623216
Name:SAMPOLSKI, JOANN (APN)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:SAMPOLSKI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S MONTPELIER AVE
Mailing Address - Street 2:APT 320
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6271
Mailing Address - Country:US
Mailing Address - Phone:609-320-8068
Mailing Address - Fax:609-645-9780
Practice Address - Street 1:1907 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1545
Practice Address - Country:US
Practice Address - Phone:609-645-8884
Practice Address - Fax:609-645-9780
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00690200364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology