MEDICARE: SAMANTHA ANNE GAMBLES FARR FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	641665	CA
2	363LF0000X	Family Nurse Practitioner	20147	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20147	OTHER	CA	FNP FURNISHING NUMBER

General Provider Information

NPI Number	:	1295971158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ANNE GAMBLES FARR FNP-C

Provider Business Mailing Address
First Line	:	500 PARNASSUS AVE FL 4
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2203
Country	:	US
Telephone Number	:	415-353-1606
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR # 8896
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1911
Country	:	US
Telephone Number	:	619-543-7202
Fax Number	:	619-543-7200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2008
Last Update Date	:	03/07/2023

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