Healthcare Provider Details

I. General information

NPI: 1649883257
Provider Name (Legal Business Name): SAMANTHA NUNAMAKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 E EMORY RD
KNOXVILLE TN
37938-4229
US

IV. Provider business mailing address

PO BOX 26194
BELFAST ME
04915-2012
US

V. Phone/Fax

Practice location:
  • Phone: 865-922-2121
  • Fax: 833-908-2092
Mailing address:
  • Phone: 865-584-4747
  • Fax: 833-908-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number221639
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28312
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28312
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: