Provider Demographics
NPI:1184268567
Name:TANTILLO, SAMANTHA MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:TANTILLO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:MARIE
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3 WALNUT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1168
Mailing Address - Country:US
Mailing Address - Phone:717-761-4141
Mailing Address - Fax:717-761-1456
Practice Address - Street 1:3 WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1168
Practice Address - Country:US
Practice Address - Phone:717-761-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021058363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care