Provider Demographics
NPI:1679928402
Name:ROZARIO, SAMANTHA (FNP, ACNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ROZARIO
Suffix:
Gender:
Credentials:FNP, ACNP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:MORAES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1540 SUNDAY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6010
Mailing Address - Country:US
Mailing Address - Phone:919-782-3456
Mailing Address - Fax:919-783-1441
Practice Address - Street 1:1540 SUNDAY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6010
Practice Address - Country:US
Practice Address - Phone:919-782-3456
Practice Address - Fax:919-783-1441
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019037363LF0000X, 363L00000X, 363LA2200X
NY6466935-1163W00000X
NYF340399-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health