Samantha Elizabeth Brock

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

42277 Issued in TN

Practice address

629 Nuckolls Rd
Bolivar, TN 38008-1599

Phone

(731) 658-3388

NPI assigned

Sep 7, 2024

Last updated

Jul 24, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784851200000",
    "number": "1609601699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081599",
            "telephone_number": "731-658-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081599",
            "telephone_number": "731-658-3388"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1132 Industrial Dr",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "TN",
            "postal_code": "383401310",
            "country_code": "US",
            "telephone_number": "731-983-3175",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "627 Nuckolls Road",
            "address_purpose": "LOCATION",
            "city": "Bolivar",
            "state": "TN",
            "postal_code": "38008",
            "country_code": "US",
            "telephone_number": "731-600-1063",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "17 1st St E",
            "address_purpose": "LOCATION",
            "city": "Stanton",
            "state": "TN",
            "postal_code": "380694426",
            "country_code": "US",
            "telephone_number": "731-548-2232",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "445 Nuckolls Rd",
            "address_purpose": "LOCATION",
            "city": "Bolivar",
            "state": "TN",
            "postal_code": "380081539",
            "country_code": "US",
            "telephone_number": "731-658-2902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCK",
        "first_name": "SAMANTHA",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-07",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "42277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bolivar Medical Clinic
• Bolivar Operator LLC (Pine Meadows Healthcare)
• Ethel Annette Bowker, RNES
• Lafonda Boyd, BLS
• Mary Brinkley, C.O.T.A.
• Brown Behavioral Health Services
• Latreace S Brown
• Kimberly Bryant-Holman, PHARM D
• Renita Gail Bufford-Jones
• Mary Jean Bufford, LCSW

• Family Nurse Practitioner in Bolivar, TN
• Providers in Bolivar, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.