Provider Demographics
NPI:1942700430
Name:SAMPSON, CRISTAL ANALISA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:ANALISA
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 WALL ST STE 306
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3403
Mailing Address - Country:US
Mailing Address - Phone:347-622-9524
Mailing Address - Fax:
Practice Address - Street 1:64 WALL ST STE 306
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3403
Practice Address - Country:US
Practice Address - Phone:347-622-9524
Practice Address - Fax:347-851-1461
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11551163WP0808X
CT136527163WP0808X
CT8618363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health