Provider Demographics
NPI:1164852703
Name:BROGAN, SAMANTHA (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BROGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MATHIS FERRY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2988
Mailing Address - Country:US
Mailing Address - Phone:843-469-1001
Mailing Address - Fax:843-388-1612
Practice Address - Street 1:250 MATHIS FERRY RD STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2988
Practice Address - Country:US
Practice Address - Phone:843-469-1001
Practice Address - Fax:843-388-1612
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27774363LF0000X
MDAC001272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily