Healthcare Provider Details

I. General information

NPI: 1295971158
Provider Name (Legal Business Name): SAMANTHA ANNE GAMBLES FARR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2008
Last Update Date: 03/07/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # 8896
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

500 PARNASSUS AVE FL 4
SAN FRANCISCO CA
94143-2203
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-7202
  • Fax: 619-543-7200
Mailing address:
  • Phone: 415-353-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number641665
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: