Healthcare Provider Details

I. General information

NPI: 1285992297
Provider Name (Legal Business Name): DESIREE ELIZABETH SAMPLES DNP, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 MORTHLAND DR SUITE 1084
VALPARAISO IN
46383-5914
US

IV. Provider business mailing address

2106 MORTHLAND DR
VALPARAISO IN
46383-5914
US

V. Phone/Fax

Practice location:
  • Phone: 219-228-1972
  • Fax: 814-292-9196
Mailing address:
  • Phone: 317-979-0733
  • Fax: 814-292-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0002282
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041581213
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number309023320
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0004318
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28164959A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003904A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: