Healthcare Provider Details

I. General information

NPI: 1992557219
Provider Name (Legal Business Name): SAMANTHA PERAZA MSN, APRN, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 ROUTE 70 E STE A
CHERRY HILL NJ
08034-2408
US

IV. Provider business mailing address

2 GAINOR AVE
MAPLE SHADE NJ
08052-3310
US

V. Phone/Fax

Practice location:
  • Phone: 856-375-6240
  • Fax: 856-375-6241
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ14980100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14980100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: