Provider Demographics
NPI:1598170409
Name:HYACINTH, SAMANTHA (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HYACINTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:HYACINTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:215 WILLOUGHBY AVENUE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205
Mailing Address - Country:US
Mailing Address - Phone:718-399-4542
Mailing Address - Fax:718-399-4544
Practice Address - Street 1:215 WILLOUGHBY AVENUE
Practice Address - Street 2:SUITE 117
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-399-4542
Practice Address - Fax:718-399-4544
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY710617163W00000X
NY421234363LW0102X
NY307680363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health