Provider Demographics
NPI:1437694726
Name:NESBETH, SAMANTHA N (APRN, AGPCNP-C)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:N
Last Name:NESBETH
Suffix:
Gender:F
Credentials:APRN, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 QUEEN ST STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1282
Mailing Address - Country:US
Mailing Address - Phone:860-839-6013
Mailing Address - Fax:
Practice Address - Street 1:963 QUEEN ST STE E
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1282
Practice Address - Country:US
Practice Address - Phone:860-839-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6892363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008074925Medicaid