Provider Demographics
NPI:1447935234
Name:SPIRO LANDRY, SAMANTHA (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SPIRO LANDRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 JAMERSON RD
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75693-2619
Mailing Address - Country:US
Mailing Address - Phone:903-522-3275
Mailing Address - Fax:
Practice Address - Street 1:6770 OLD JACKSONVILLE HWY STE 103
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0576
Practice Address - Country:US
Practice Address - Phone:903-522-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1126447363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner