Provider Demographics
NPI:1023673407
Name:FOX, SAMANTHA JOLINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOLINE
Last Name:FOX
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 CARLISLE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-2531
Mailing Address - Country:US
Mailing Address - Phone:423-367-3101
Mailing Address - Fax:
Practice Address - Street 1:300 MOORE ST STE B
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-4495
Practice Address - Country:US
Practice Address - Phone:276-591-5448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner