Provider Demographics
NPI:1902002892
Name:VENABLE, SAMANTHA JOANN (NP)
Entity Type:Individual
Prefix:PROF
First Name:SAMANTHA
Middle Name:JOANN
Last Name:VENABLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20901 PORTER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3363
Mailing Address - Country:US
Mailing Address - Phone:949-589-6708
Mailing Address - Fax:949-589-3638
Practice Address - Street 1:20901 PORTER RANCH RD
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3363
Practice Address - Country:US
Practice Address - Phone:949-589-6708
Practice Address - Fax:949-589-3638
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily