Provider Demographics
NPI:1780711226
Name:NEWCOM, SAMANTHA SUZANNE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:SUZANNE
Last Name:NEWCOM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:SUZANNE
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 36207
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6207
Mailing Address - Country:US
Mailing Address - Phone:520-577-3333
Mailing Address - Fax:520-577-4685
Practice Address - Street 1:4930 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5615
Practice Address - Country:US
Practice Address - Phone:520-577-3333
Practice Address - Fax:520-577-4685
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2199363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ232193Medicaid
AZZ125234Medicare UPIN
AZ232193Medicaid