Healthcare Provider Details

I. General information

NPI: 1598170409
Provider Name (Legal Business Name): SAMANTHA HYACINTH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA HYACINTH

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-2037
  • Fax: 410-955-0737
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR254166
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307680
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421234
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number710617
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: