Provider Demographics
NPI:1639312671
Name:SAMUEL, ANNA R (ACNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:R
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-465-3624
Mailing Address - Fax:903-465-3973
Practice Address - Street 1:5026 POOL RD
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4595
Practice Address - Country:US
Practice Address - Phone:903-465-3624
Practice Address - Fax:903-465-3973
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716738363LA2100X
TN13998364SA2100X
TXAP124352363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329130401Medicaid
TX329130402Medicaid
TX8515NFOtherBCBS
TX331622YMGJOtherMEDICARE PIN
TX329130404Medicaid
TX331622YMGJOtherMEDICARE PIN
TX329130401Medicaid
TX329130401Medicaid