Provider Demographics
NPI:1215481924
Name:COLLINS, SAMANTHA ALEXANDRIA (DNP,FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALEXANDRIA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DNP,FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ALEXANDRIA
Other - Last Name:BARCZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-1530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-2782
Practice Address - Country:US
Practice Address - Phone:314-687-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014613363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1215481924Medicaid