Healthcare Provider Details

I. General information

NPI: 1700428208
Provider Name (Legal Business Name): SAMANTHA RAHEL COLLIER WEBB MSN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 ALVIN AVE STE 60
SAN JOSE CA
95121-1664
US

IV. Provider business mailing address

281 INGRAM CT
SAN JOSE CA
95139-1426
US

V. Phone/Fax

Practice location:
  • Phone: 408-274-7100
  • Fax:
Mailing address:
  • Phone: 707-655-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: