Provider Demographics
NPI:1093301228
Name:SIMON, WINIFRED AGHOGHOVBIA (FNP)
Entity Type:Individual
Prefix:MISS
First Name:WINIFRED
Middle Name:AGHOGHOVBIA
Last Name:SIMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5505 BROADWAY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3671
Mailing Address - Country:US
Mailing Address - Phone:214-275-5256
Mailing Address - Fax:214-275-5284
Practice Address - Street 1:5505 BROADWAY BLVD STE B
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3671
Practice Address - Country:US
Practice Address - Phone:214-275-5256
Practice Address - Fax:214-275-5284
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily