Healthcare Provider Details

I. General information

NPI: 1689387128
Provider Name (Legal Business Name): SAMANTHA CARRY APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14665 GALAXIE AVE STE 140
APPLE VALLEY MN
55124-4509
US

IV. Provider business mailing address

3250 W 66TH ST APT 347
EDINA MN
55435-5512
US

V. Phone/Fax

Practice location:
  • Phone: 651-456-8494
  • Fax:
Mailing address:
  • Phone: 612-208-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9834
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: