1225888522 NPI number — SAMANTHA NICOLE-MARIE FAZZINGO BSN, RN

Table of content: SAMANTHA NICOLE-MARIE FAZZINGO BSN, RN (NPI 1225888522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225888522 NPI number — SAMANTHA NICOLE-MARIE FAZZINGO BSN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAZZINGO
Provider First Name:
SAMANTHA
Provider Middle Name:
NICOLE-MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANGHORNE
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225888522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SCHOOL OF NURSING
Provider Second Line Business Mailing Address:
CBX 063
Provider Business Mailing Address City Name:
MILLEDGEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-388-5434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 TURNER MCCALL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-388-5434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN299170 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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