Provider Demographics
NPI:1407409220
Name:ROTHMAN, SAMANTHA ELIZABETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ELIZABETH
Other - Last Name:SIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:401 N 11TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1901
Mailing Address - Country:US
Mailing Address - Phone:804-828-5883
Mailing Address - Fax:
Practice Address - Street 1:401 N 11TH ST FL VA232191
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1901
Practice Address - Country:US
Practice Address - Phone:804-828-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60986180363LF0000X
VA0024179494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily