MEDICARE: SAMANTHA DEPASQUALE

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	255861	AZ

General Provider Information

NPI Number	:	1184566358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA DEPASQUALE

Provider Business Mailing Address
First Line	:	314 E SEQUOIA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-1628
Country	:	US
Telephone Number	:	602-461-9307
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 E SEQUOIA DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-1628
Country	:	US
Telephone Number	:	602-461-9307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ SAMANTHA DEPASQUALE ” Practice Location

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