Provider Demographics
NPI:1710499231
Name:ELLIOTT, SAMANTHA NICOLE (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41420 NORTHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1251
Mailing Address - Country:US
Mailing Address - Phone:440-541-4260
Mailing Address - Fax:
Practice Address - Street 1:26032 DETROIT RD STE 1
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2478
Practice Address - Country:US
Practice Address - Phone:440-250-9414
Practice Address - Fax:440-250-9457
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.384205163W00000X, 163WP0808X
OHAPRN.CNP.0036073363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health