Provider Demographics
NPI:1194384602
Name:HALL, SAMUEL TODD (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:TODD
Last Name:HALL
Suffix:
Gender:M
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 1:201 S OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76087-1793
Mailing Address - Country:US
Mailing Address - Phone:817-599-5518
Mailing Address - Fax:817-599-5528
Practice Address - Street 1:201 S OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:HUDSON OAKS
Practice Address - State:TX
Practice Address - Zip Code:76087-1793
Practice Address - Country:US
Practice Address - Phone:817-599-5518
Practice Address - Fax:817-599-5528
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX829408OtherTEXAS BOARD OF NURSING RN LICENSE
TXAP141809OtherAPRN LICENSE NUMBER