SAMANTHA MARTIN AGACNP-BC NPI 1396314308

NPI Information

  • NPI: 1396314308
  • Provider Name: SAMANTHA MARTIN, AGACNP-BC
  • Classification: Nurse Practitioner - 363LA2100X
  • Specialization: Acute Care
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: ADDRESS: 530 NE GLEN OAK AVE
    PEORIA, IL
    ZIP 61637
  • Phone: (309) 655-2000

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NPI Details

Samantha Martin, AGACNP-BC is an acute care nurse practitioner in Peoria, IL with 5 years of experience. Samantha Martin, AGACNP-BC NPI is 1396314308. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

ADDRESS: 530 NE GLEN OAK AVE
PEORIA, IL
ZIP 61637-001
Phone: (309) 655-2000

The NPI 1396314308 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/23/2021 and was last updated on 6/23/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LA2100XNurse PractitionerAcute Care209022870ILLINOISYes
2363LG0600XNurse PractitionerGerontology209022870ILLINOISNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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