Provider Demographics
NPI:1851139505
Name:CEARLOCK, SAMANTHA M (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:CEARLOCK
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:M
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:WITT
Mailing Address - State:IL
Mailing Address - Zip Code:62094-0325
Mailing Address - Country:US
Mailing Address - Phone:217-343-8002
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 325
Practice Address - Street 2:
Practice Address - City:WITT
Practice Address - State:IL
Practice Address - Zip Code:62094-0325
Practice Address - Country:US
Practice Address - Phone:217-343-8002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041382961163W00000X
IL209029330363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse