Provider Demographics
NPI:1497253256
Name:TAN, SAMANTHA M (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:TAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:M
Other - Last Name:CIKESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-9262
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:808 RICKERT DR STE 103
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0908
Practice Address - Country:US
Practice Address - Phone:888-963-6437
Practice Address - Fax:630-348-3098
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016922363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily