Healthcare Provider Details

I. General information

NPI: 1639834492
Provider Name (Legal Business Name): SAMANTHA EBERT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 KINGSBOROUGH SQ STE 100
CHESAPEAKE VA
23320-5041
US

IV. Provider business mailing address

901 BOWLING GREEN TRL
CHESAPEAKE VA
23320-3111
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9294
  • Fax: 757-213-9345
Mailing address:
  • Phone: 949-690-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024197789
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: