Healthcare Provider Details

I. General information

NPI: 1578135679
Provider Name (Legal Business Name): SAMANTHA MARIE HUGHES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N DUTTON AVE
SANTA ROSA CA
95401-7112
US

IV. Provider business mailing address

1300 N DUTTON AVE
SANTA ROSA CA
95401-7112
US

V. Phone/Fax

Practice location:
  • Phone: 707-396-5151
  • Fax: 707-303-3611
Mailing address:
  • Phone: 707-396-5151
  • Fax: 707-303-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: