Healthcare Provider Details

I. General information

NPI: 1710499231
Provider Name (Legal Business Name): SAMANTHA NICOLE ELLIOTT MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26032 DETROIT RD STE 1
WESTLAKE OH
44145-2478
US

IV. Provider business mailing address

41420 NORTHWOOD ST
ELYRIA OH
44035-1251
US

V. Phone/Fax

Practice location:
  • Phone: 440-250-9414
  • Fax: 440-250-9457
Mailing address:
  • Phone: 440-541-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0036073
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.384205
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN.384205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: