Provider Demographics
NPI:1003451295
Name:MAKINA, SAMANTHA RUFARO
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RUFARO
Last Name:MAKINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10637 MUSKETBALL PL
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-5959
Mailing Address - Country:US
Mailing Address - Phone:469-464-7220
Mailing Address - Fax:
Practice Address - Street 1:10637 MUSKETBALL PL
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-5959
Practice Address - Country:US
Practice Address - Phone:469-464-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143938363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care