Provider Demographics
NPI:1679398192
Name:BASSLER, SAMANTHA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:BASSLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4428 LORING RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1470
Mailing Address - Country:US
Mailing Address - Phone:320-296-6223
Mailing Address - Fax:
Practice Address - Street 1:3636 VIRGINIA BEACH BLVD STE 110
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3400
Practice Address - Country:US
Practice Address - Phone:757-744-4218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA002419395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine