Provider Demographics
NPI:1700137882
Name:SAMPLES, ROBERTA ANN (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ANN
Last Name:SAMPLES
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 EAST ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007
Mailing Address - Country:US
Mailing Address - Phone:530-365-2545
Mailing Address - Fax:530-365-3871
Practice Address - Street 1:2830 EAST ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007
Practice Address - Country:US
Practice Address - Phone:530-365-2545
Practice Address - Fax:530-365-3871
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA659185163WC0200X
CA22604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine