Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 113068 | OK |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 113068 | OK |
NPI | 1063044386 |
---|---|
Provider Name | Mrs. Samantha Taylor Hart |
First Address | Tulsa, OK 74136-1902 |
Second Address | Tulsa, OK 74136-1902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2020 |
Last Update Date | 07/09/2021 |