=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194335919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA PERRY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2020
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1771 N PIERCE ST STE 300
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22209-1828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-663-6331
-----------------------------------------------------
Fax | 415-252-7176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 EMBARCADERO CTR STE 1900
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94111-3723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-658-6791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AC003235
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------