Provider Demographics
NPI:1427793702
Name:CARROLL, SAMANTHA TAYLOR (RN)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:TAYLOR
Last Name:CARROLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8217
Mailing Address - Country:US
Mailing Address - Phone:516-305-9732
Mailing Address - Fax:
Practice Address - Street 1:130 W SHORE DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-8217
Practice Address - Country:US
Practice Address - Phone:516-305-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721843163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse