Provider Demographics
NPI:1467975698
Name:NAZAROFF, SAMANTHA JUNE (DNP)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JUNE
Last Name:NAZAROFF
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 BACK ACRE CIR STE 290B
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7769
Mailing Address - Country:US
Mailing Address - Phone:480-228-3323
Mailing Address - Fax:
Practice Address - Street 1:2702 BACK ACRE CIR STE 290B
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-7769
Practice Address - Country:US
Practice Address - Phone:301-703-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10364363LA2200X
MDR251853363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD208246200Medicaid