Provider Demographics
NPI:1417626490
Name:ZEISLOFT, SAMANTHA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ZEISLOFT
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-2125
Mailing Address - Country:US
Mailing Address - Phone:770-654-6835
Mailing Address - Fax:773-824-2303
Practice Address - Street 1:9725 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3841
Practice Address - Country:US
Practice Address - Phone:678-674-4004
Practice Address - Fax:773-824-2303
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0101357-C-NP363LP0808X
GARN285551363LP0808X
WAAP61489940363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty