Healthcare Provider Details

I. General information

NPI: 1659209484
Provider Name (Legal Business Name): SAMANTHA JADE CHITWOOD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD STE 106
MESA AZ
85202-4769
US

IV. Provider business mailing address

1432 S DOBSON RD STE 106
MESA AZ
85202-4769
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-3637
  • Fax: 480-969-6568
Mailing address:
  • Phone: 480-969-3637
  • Fax: 480-969-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2026019320
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: