Provider Demographics
NPI:1518564194
Name:CERQUA, SAMANTHA L (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:CERQUA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 HARLAN ST STE 340
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7418
Mailing Address - Country:US
Mailing Address - Phone:630-453-1259
Mailing Address - Fax:
Practice Address - Street 1:1391 SPEER BLVD STE 360
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2632
Practice Address - Country:US
Practice Address - Phone:303-720-1845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996725-NP363LP0808X
IL209.022168363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health