Healthcare Provider Details

I. General information

NPI: 1760366603
Provider Name (Legal Business Name): SAMANTHA ROCHE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 1400 S
GARLAND UT
84312-9100
US

IV. Provider business mailing address

10990 W 9600 N
TREMONTON UT
84337-9213
US

V. Phone/Fax

Practice location:
  • Phone: 435-257-3684
  • Fax:
Mailing address:
  • Phone: 208-240-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTBD
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: