Provider Demographics
NPI:1891274189
Name:SACCOCCIA, SAMANTHA (NP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SACCOCCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:455 TOLLGATE RD
Mailing Address - Street 2:PROFESSIONAL REVENUE CYCLE & CREDENTIALING
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:
Practice Address - Street 1:455 TOLLGATE RD
Practice Address - Street 2:ASP BLDG
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0288
Practice Address - Country:US
Practice Address - Phone:401-681-4996
Practice Address - Fax:401-921-6569
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2304854363L00000X
RIAPRN02716363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner