Provider Demographics
NPI:1013609874
Name:LEOS, SAMANTHA JO (RN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:LEOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 W MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85194-6899
Mailing Address - Country:US
Mailing Address - Phone:520-494-4883
Mailing Address - Fax:
Practice Address - Street 1:2730 N TREKELL RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1019
Practice Address - Country:US
Practice Address - Phone:520-836-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ221249251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care