Provider Demographics
NPI:1245631548
Name:PIAZZA, SAMANTHA M (APRN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:M
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:M
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:204 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4720
Mailing Address - Country:US
Mailing Address - Phone:508-826-2787
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-5860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily