Healthcare Provider Details

I. General information

NPI: 1669180543
Provider Name (Legal Business Name): SAMANTHA LOUISE DERFLER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S 1100 E
AMERICAN FORK UT
84003-2829
US

IV. Provider business mailing address

212 S 1100 E
AMERICAN FORK UT
84003-2829
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-0901
  • Fax: 801-763-0902
Mailing address:
  • Phone: 801-763-0901
  • Fax: 801-763-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7703032-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7703032-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: