Provider Demographics
NPI:1225888522
Name:FAZZINGO, SAMANTHA NICOLE-MARIE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NICOLE-MARIE
Last Name:FAZZINGO
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:LANGHORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:SCHOOL OF NURSING
Mailing Address - Street 2:CBX 063
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061
Mailing Address - Country:US
Mailing Address - Phone:517-388-5434
Mailing Address - Fax:
Practice Address - Street 1:304 TURNER MCCALL BLVD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:517-388-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN299170163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse