Provider Demographics
NPI:1760366603
Name:ROCHE, SAMANTHA (FNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ROCHE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10990 W 9600 N
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-9213
Mailing Address - Country:US
Mailing Address - Phone:208-240-4590
Mailing Address - Fax:
Practice Address - Street 1:300 W 1400 S
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:UT
Practice Address - Zip Code:84312-9100
Practice Address - Country:US
Practice Address - Phone:435-257-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTTBD363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily