Healthcare Provider Details

I. General information

NPI: 1821924739
Provider Name (Legal Business Name): SAMANTHA NICOLE GRIMSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6379 CENTER DR
NORFOLK VA
23502-4102
US

IV. Provider business mailing address

1780 ASHLAR LN
CHESAPEAKE VA
23320-3115
US

V. Phone/Fax

Practice location:
  • Phone: 757-467-4200
  • Fax:
Mailing address:
  • Phone: 757-642-7583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: