Provider Demographics
NPI:1952062192
Name:THOMAS, SAMANTHA CHRISTINE (AGACNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CHRISTINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2879 SORRENTO AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6931
Mailing Address - Country:US
Mailing Address - Phone:734-972-2615
Mailing Address - Fax:
Practice Address - Street 1:2879 SORRENTO AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6931
Practice Address - Country:US
Practice Address - Phone:734-972-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704369299363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care