Provider Demographics
NPI:1659932978
Name:ROBERTS, TAYLOR SAMANTHA (AGACNP, FNP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SAMANTHA
Last Name:ROBERTS
Suffix:
Gender:
Credentials:AGACNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 GERMANTOWN CIR APT 715
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-1857
Mailing Address - Country:US
Mailing Address - Phone:423-653-2242
Mailing Address - Fax:
Practice Address - Street 1:2030 HAMILTON PLACE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6040
Practice Address - Country:US
Practice Address - Phone:423-602-9895
Practice Address - Fax:423-553-1829
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN192284163W00000X
TN26189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse