Healthcare Provider Details

I. General information

NPI: 1679164016
Provider Name (Legal Business Name): SAMANTHA LYNN MATTHEWS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 BARNUM AVE
BRIDGEPORT CT
06608-2409
US

IV. Provider business mailing address

471 BARNUM AVE
BRIDGEPORT CT
06608-2409
US

V. Phone/Fax

Practice location:
  • Phone: 203-333-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015169
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15460
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1203369
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: