Healthcare Provider Details

I. General information

NPI: 1437694726
Provider Name (Legal Business Name): SAMANTHA N NESBETH APRN, AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7223 LEE DEFOREST DR
COLUMBIA MD
21046-3236
US

IV. Provider business mailing address

148 ELMWOOD DR
MERIDEN CT
06450-7311
US

V. Phone/Fax

Practice location:
  • Phone: 888-800-1854
  • Fax:
Mailing address:
  • Phone: 203-623-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF308069
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6892
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF308069
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF308069
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308069
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number6892
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number6892
License Number StateCT
# 8
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6892
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: