Provider Demographics
NPI:1750964029
Name:COGSWELL, HEATHER MARIE SAMANIEGO (FNP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER MARIE
Middle Name:SAMANIEGO
Last Name:COGSWELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HEATHER MARIE
Other - Middle Name:ACUNA
Other - Last Name:SAMANIEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:1690 FORT CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-7531
Mailing Address - Country:US
Mailing Address - Phone:609-634-7748
Mailing Address - Fax:
Practice Address - Street 1:1690 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-7531
Practice Address - Country:US
Practice Address - Phone:931-648-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine