Provider Demographics
NPI:1255977492
Name:SHAW, SAMANTHA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KRAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:11510 E RANCH GATE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8235
Mailing Address - Country:US
Mailing Address - Phone:904-599-3209
Mailing Address - Fax:
Practice Address - Street 1:3805 E BELL RD STE 2400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2181
Practice Address - Country:US
Practice Address - Phone:833-696-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN214222163W00000X
AL1-161951163W00000X
AZ264757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse