Healthcare Provider Details

I. General information

NPI: 1821722943
Provider Name (Legal Business Name): SAMANTHA CHANEL BARBOSA POTENCIANO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA CHANEL BARBOSA DE VERA APRN

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SIERRA ROSE DR
RENO NV
89511-2060
US

IV. Provider business mailing address

6036 BARRETT CT
SPARKS NV
89436-4400
US

V. Phone/Fax

Practice location:
  • Phone: 775-600-4717
  • Fax: 775-829-3757
Mailing address:
  • Phone: 926-672-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number857646
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number857646
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN89299
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number857646
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: