Provider Demographics
NPI:1689237810
Name:STOCKREEF, SAMANTHA A (RN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:STOCKREEF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 N OLD ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5237
Mailing Address - Country:US
Mailing Address - Phone:903-519-2627
Mailing Address - Fax:
Practice Address - Street 1:906 N OLD ROBINSON RD
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:TX
Practice Address - Zip Code:76706-5237
Practice Address - Country:US
Practice Address - Phone:903-519-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738886146L00000X
TX945393163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39107126OtherDRIVER LICENSE
TX945393OtherRN