Provider Demographics
NPI:1073922217
Name:MATSON, SAMANTHA M (NP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:MATSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 GLENN MITCHELL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0167
Mailing Address - Country:US
Mailing Address - Phone:757-507-8610
Mailing Address - Fax:757-510-9350
Practice Address - Street 1:1975 GLENN MITCHELL DR STE 202
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-507-8610
Practice Address - Fax:757-510-9350
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171877363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care