Basic Information
| Provider Information | |||||||||
| NPI: | 1194332007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAMBLIN | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1385 W BRIERBROOK RD | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381382208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013902930 | ||||||||
| FaxNumber: | 9013902940 | ||||||||
| Practice Location | |||||||||
| Address1: | 1385 W BRIERBROOK RD | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381382208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013902930 | ||||||||
| FaxNumber: | 9013902940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2020 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 903994 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 163WG0000X | 903994 | MS | N | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.