Provider Demographics
NPI:1710774195
Name:RAMOS, SAMANTHA MONIQUE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MONIQUE
Last Name:RAMOS
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 SR 77
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-9089
Mailing Address - Country:US
Mailing Address - Phone:575-714-7267
Mailing Address - Fax:
Practice Address - Street 1:2421 W 21ST ST STE B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-2006
Practice Address - Country:US
Practice Address - Phone:575-769-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner