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General NPI Number Information
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NPI Number | 1255977492
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Entity Type | Individual
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Provider Name | SAMANTHA SHAW MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 3805 E BELL RD STE 2400
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City | PHOENIX
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State | AZ
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Zip | 85032-2181
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Country | US
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Telephone | 833-696-3349
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Fax |
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Provider Business Mailing Address
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Address Line | 11510 E RANCH GATE RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-8235
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Country | US
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Telephone | 904-599-3209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 264757
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN214222
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-161951
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License Number State | AL
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