| Doctor Name: | SAMARA AMBROSIO |
| NPI Number: | 1255700696 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 006294 |
| Business Practice Address: | 400 Capital Blvd Fl 3 Rocky Hill, CT - 060673576 |
| Business Phone Number: | 8886979058 |
| Business Fax Number: | |
| Mailing Address: | 8 Harvest Hill Rd, WEST SIMSBURY |
| State: | CT |
| Postal Code: | 060922221 |
| Phone Number: | 8608828857 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2015 |
| NPI Last Update Date: | 09/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 006294 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |