Healthcare Provider Details

I. General information

NPI: 1255111043
Provider Name (Legal Business Name): SAMANTHA TARVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17866 GRAY MOSS AVENUE
BATON ROUGE LA
70817-1737
US

IV. Provider business mailing address

17866 GRAY MOSS AVE
BATON ROUGE LA
70817-1737
US

V. Phone/Fax

Practice location:
  • Phone: 504-256-1138
  • Fax:
Mailing address:
  • Phone: 504-256-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number247084
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: