Healthcare Provider Details

I. General information

NPI: 1417663584
Provider Name (Legal Business Name): SARINA ANN SAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-9718
US

IV. Provider business mailing address

17273 STATE ROUTE 104
CHILLICOTHEE OH
45601-9718
US

V. Phone/Fax

Practice location:
  • Phone: 740-253-4093
  • Fax:
Mailing address:
  • Phone: 740-773-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032567
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: