Provider Demographics
NPI:1689449316
Name:OSAFO, SAMUEL OFOSU (NP)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:OFOSU
Last Name:OSAFO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14163 ROCKINGHORSE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-3769
Mailing Address - Country:US
Mailing Address - Phone:571-278-5430
Mailing Address - Fax:
Practice Address - Street 1:14163 ROCKINGHORSE DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3769
Practice Address - Country:US
Practice Address - Phone:571-278-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily