Healthcare Provider Details

I. General information

NPI: 1497253256
Provider Name (Legal Business Name): SAMANTHA M TAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA M CIKESH FNP-C

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RANDALL RD
GENEVA IL
60134-4200
US

IV. Provider business mailing address

300 RANDALL RD
GENEVA IL
60134-4200
US

V. Phone/Fax

Practice location:
  • Phone: 630-208-4000
  • Fax: 630-208-3460
Mailing address:
  • Phone: 630-208-4000
  • Fax: 630-208-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.016922
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.016922
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: