Samantha Tully, NP
Nurse Practitioner, Family in Boise, ID. Individual provider (NPI-1).
NPI number1265320105
StatusActive
Last updated in NPPESJul 11, 2025
Details
- NPI
- 1265320105
- Entity type
- Individual (NPI-1)
- Name
- Samantha Tully
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 27, 2025
- Certification date
- Jul 11, 2025
- Last updated
- Jul 11, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 5671261 | ID | Yes |
Practice location
190 E Bannock StBoise, ID 83712-6241
Phone 208-381-2222
Mailing address
190 E Bannock StBoise, ID 83712-6241
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