Healthcare Provider Details

I. General information

NPI: 1487364667
Provider Name (Legal Business Name): SAMANTHA PRIBULA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HERITAGE WOODS DR
COPLEY OH
44321-2791
US

IV. Provider business mailing address

5476 DIANA LYNN DR
STOW OH
44224-1649
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-0980
  • Fax:
Mailing address:
  • Phone: 330-696-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032563
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN.CNP.0032563
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: