Provider Demographics
NPI:1285992297
Name:SAMPLES, DESIREE ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:ELIZABETH
Last Name:SAMPLES
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 15TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-9393
Mailing Address - Country:US
Mailing Address - Phone:219-270-3358
Mailing Address - Fax:814-292-9196
Practice Address - Street 1:1317 15TH ST SE
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310-9393
Practice Address - Country:US
Practice Address - Phone:219-270-3358
Practice Address - Fax:814-292-9196
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28164959A363LF0000X
IN71003904A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily