Provider Demographics
NPI:1518419563
Name:CONROY, SAMANTHA (FNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:CONROY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 GOLF LINKS RD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4837
Mailing Address - Country:US
Mailing Address - Phone:951-514-8741
Mailing Address - Fax:
Practice Address - Street 1:4990 E MEDITERRANEAN DR STE A
Practice Address - Street 2:STE A
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2495
Practice Address - Country:US
Practice Address - Phone:520-439-5186
Practice Address - Fax:520-439-4466
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily