Provider Demographics
NPI:1972283968
Name:ABU SAMAKE, AHMED
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ABU SAMAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7608 NOVELLA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-4319
Mailing Address - Country:US
Mailing Address - Phone:702-372-6089
Mailing Address - Fax:
Practice Address - Street 1:7608 NOVELLA DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-4319
Practice Address - Country:US
Practice Address - Phone:702-372-6089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX957625163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics