Provider Demographics
NPI:1366093486
Name:BRUMFIELD, SAMANTHA JO (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JO
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2195 QUEENSBERRY RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3323
Mailing Address - Country:US
Mailing Address - Phone:225-315-1575
Mailing Address - Fax:
Practice Address - Street 1:5562 CENTRAL AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91762
Practice Address - Country:US
Practice Address - Phone:713-589-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012816363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care