Healthcare Provider Details

I. General information

NPI: 1649005877
Provider Name (Legal Business Name): SAMUEL ARCHINO JR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 WESTERN BLVD
JACKSONVILLE NC
28546-6338
US

IV. Provider business mailing address

PO BOX 821
SWANSBORO NC
28584-0821
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-2345
  • Fax:
Mailing address:
  • Phone: 252-702-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5020874
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number235585
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: