Healthcare Provider Details

I. General information

NPI: 1578427779
Provider Name (Legal Business Name): SAMANTHA COLLINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 GATEWAY BLVD
NEWBURGH IN
47630-7451
US

IV. Provider business mailing address

PO BOX 632111
CINCINNATI OH
45263-2111
US

V. Phone/Fax

Practice location:
  • Phone: 812-858-3051
  • Fax:
Mailing address:
  • Phone: 812-450-6879
  • Fax: 812-450-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71017523A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: