Provider Demographics
NPI:1043067028
Name:PIAZZOLLA, SAMANTHA R (APRN, CNP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:R
Last Name:PIAZZOLLA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15300 WEST AVE STE 100A
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4600
Mailing Address - Country:US
Mailing Address - Phone:708-226-2318
Mailing Address - Fax:708-226-2319
Practice Address - Street 1:15300 WEST AVE STE 100A
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-226-2318
Practice Address - Fax:708-226-2319
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209029721363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner