Healthcare Provider Details

I. General information

NPI: 1205719895
Provider Name (Legal Business Name): SAMANTHA JO FLAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA JO SIMMONS

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 GLENWOOD AVE
EASTON MD
21601-4104
US

IV. Provider business mailing address

307 GLENWOOD AVE
EASTON MD
21601-4104
US

V. Phone/Fax

Practice location:
  • Phone: 443-496-3201
  • Fax: 833-914-0414
Mailing address:
  • Phone: 443-496-3201
  • Fax: 833-914-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: