Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Samantha Ellen Fullmer

Individual provider Family Nurse Practitioner · NPI 1265031496

Samantha Ellen Fullmer is a Nurse Practitioner in Mesa, Arizona. Qualified in 2020, 6 years ago. Practices with Goldfield Medical Clinics LLC, a 3-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
6
Licensed in
AZ
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

1705 W Main St
Mesa, AZ 85201-6920
Phone: (480) 964-2273
Fax: (480) 718-9477
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 223113 (AZ)
General Practice Physician Taxonomy 208D00000X · Licence 223113 (AZ)

Record details

NPI number1265031496
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 19, 2020
Last updated in NPPESMay 3, 2023
Certification dateMay 3, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Goldfield Medical Clinics Llc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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