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General NPI Number Information
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NPI Number | 1710499231
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Entity Type | Individual
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Provider Name | SAMANTHA NICOLE ELLIOTT MSN, APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 26032 DETROIT RD STE 1
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City | WESTLAKE
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State | OH
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Zip | 44145-2478
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Country | US
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Telephone | 440-250-9414
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Fax | 440-250-9457
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Provider Business Mailing Address
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Address Line | 41420 NORTHWOOD ST
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City | ELYRIA
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State | OH
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Zip | 44035-1251
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Country | US
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Telephone | 440-541-4260
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0036073
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License Number State | OH
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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 | RN.384205
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN.384205
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License Number State | OH
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