MEDICARE: SAMANTHA LOGAN SPINKS APN

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	363LA2100X	Acute Care Nurse Practitioner	21159	TN

General Provider Information

NPI Number	:	1649629049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LOGAN SPINKS APN

Provider Business Mailing Address
First Line	:	2404 CHAMBLISS AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3848
Country	:	US
Telephone Number	:	423-339-2000
Fax Number	:	423-339-2043

Provider Business Practice Location Address
First Line	:	2404 CHAMBLISS AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3848
Country	:	US
Telephone Number	:	423-339-2000
Fax Number	:	423-339-2043

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

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	06/07/2016

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