Provider Demographics
NPI:1922240498
Name:MESHACK-HART, SAMANTHA (NP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:MESHACK-HART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 GARRITY BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9222
Mailing Address - Country:US
Mailing Address - Phone:855-434-7763
Mailing Address - Fax:949-281-5550
Practice Address - Street 1:4301 GARRITY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9222
Practice Address - Country:US
Practice Address - Phone:855-434-7763
Practice Address - Fax:949-281-5550
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050107NP363LF0000X
IDNP-1516A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily