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NPI Code Detail

MEDICARE: SAMANTHA MARIE HYDES APRN, FNP-BC

MEDICARE: SAMANTHA MARIE HYDES APRN, FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN262052GA
2363LF0000XFamily Nurse PractitionerRN262052GA

General Provider Information

NPI Number : 1114426806
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA MARIE HYDES APRN, FNP-BC
Provider Business Mailing Address
First Line : 1160 BRIARCLIFF RD NE APT 1
Second Line :
City : ATLANTA
State : GA
Zip : 30306-2661
Country : US
Telephone Number : 954-562-7332
Fax Number :
Provider Business Practice Location Address
First Line : 3350 BRECKINRIDGE BLVD STE 200
Second Line :
City : DULUTH
State : GA
Zip : 30096-4959
Country : US
Telephone Number : 678-990-6422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2018
Last Update Date : 05/01/2019

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