Provider Demographics
NPI:1003092610
Name:SIMS, NIKKI G
Entity Type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:G
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 LAS CRUCES DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4843
Mailing Address - Country:US
Mailing Address - Phone:407-222-2115
Mailing Address - Fax:407-695-8329
Practice Address - Street 1:1219 LAS CRUCES DR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4843
Practice Address - Country:US
Practice Address - Phone:407-222-2115
Practice Address - Fax:407-695-8329
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0753181710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman