Provider Demographics
NPI:1023781523
Name:LANGE, SAMANTHA MARY GIMELLI (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARY GIMELLI
Last Name:LANGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26229 E MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-4671
Mailing Address - Country:US
Mailing Address - Phone:720-939-0605
Mailing Address - Fax:
Practice Address - Street 1:1775 AURORA CT RM 2404
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2536
Practice Address - Country:US
Practice Address - Phone:303-724-7514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1628476163W00000X
COAPN.0996681-NP363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily