MEDICARE: MRS. SAMANTHA REIS APRN, FNP-BC, CEN

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	207Q00000X	Family Medicine Physician	AP142039	TX
2	363LF0000X	Family Nurse Practitioner	AP142039	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP142039	OTHER	TX	TEXAS APRN LICENSE

General Provider Information

NPI Number	:	1497317564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA REIS APRN, FNP-BC, CEN

Provider Business Mailing Address
First Line	:	7801 COUNTY ROAD 915B
Second Line	:
City	:	JOSHUA
State	:	TX
Zip	:	76058-2200
Country	:	US
Telephone Number	:	817-907-4014
Fax Number	:

Provider Business Practice Location Address
First Line	:	5653 MCPHERSON BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-6023
Country	:	US
Telephone Number	:	682-354-3100
Fax Number	:

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

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	11/09/2022

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