Healthcare Provider Details

I. General information

NPI: 1497390892
Provider Name (Legal Business Name): SAMANTHA CACERES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2019
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
JB MDL NJ
08641-5312
US

IV. Provider business mailing address

3458 NEELY RD
JB MDL NJ
08641-5312
US

V. Phone/Fax

Practice location:
  • Phone: 866-377-2778
  • Fax: 609-754-9249
Mailing address:
  • Phone: 866-377-2778
  • Fax: 609-754-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95097433
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018825
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15192000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: