Provider Demographics
NPI:1760842314
Name:TOUCHTON, SAMARA (FNP)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:
Last Name:TOUCHTON
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 1:307 BARROWS ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-1309
Mailing Address - Country:US
Mailing Address - Phone:610-413-3537
Mailing Address - Fax:
Practice Address - Street 1:1301 TRUMANSBURG RD
Practice Address - Street 2:SUITE P
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1397
Practice Address - Country:US
Practice Address - Phone:607-277-2365
Practice Address - Fax:607-277-1415
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily