Healthcare Provider Details

I. General information

NPI: 1467939835
Provider Name (Legal Business Name): SAMANTHA ANGELICA SWEITZER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 S SYCAMORE ST
PETERSBURG VA
23803-5039
US

IV. Provider business mailing address

805 N 24TH ST APT 1
RICHMOND VA
23223-6409
US

V. Phone/Fax

Practice location:
  • Phone: 804-957-9601
  • Fax: 804-957-5850
Mailing address:
  • Phone: 571-527-9605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176414
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: