Provider Demographics
NPI:1386111474
Name:SAMPSON, JOANNA J (NP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:J
Last Name:SAMPSON
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 1:205 YOAKUM PKWY UNIT 1714
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3844
Mailing Address - Country:US
Mailing Address - Phone:202-731-7970
Mailing Address - Fax:
Practice Address - Street 1:205 YOAKUM PKWY UNIT 1714
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3844
Practice Address - Country:US
Practice Address - Phone:202-731-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily