Provider Demographics
NPI:1821722943
Name:POTENCIANO, SAMANTHA CHANEL BARBOSA (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA CHANEL
Middle Name:BARBOSA
Last Name:POTENCIANO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SAMANTHA CHANEL
Other - Middle Name:BARBOSA
Other - Last Name:DE VERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6036 BARRETT CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-4400
Mailing Address - Country:US
Mailing Address - Phone:926-672-0884
Mailing Address - Fax:
Practice Address - Street 1:655 SIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-600-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN89299163WC0200X
NV857646363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine