Provider Demographics
NPI:1144202383
Name:BRADY, SIMONE H (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:H
Last Name:BRADY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 EAGLE BAY LN BAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-8377
Mailing Address - Country:US
Mailing Address - Phone:443-789-1818
Mailing Address - Fax:850-534-4171
Practice Address - Street 1:8186 LARK BROWN RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6433
Practice Address - Country:US
Practice Address - Phone:410-730-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC32680808892083X0100X
MDR115117363LF0000X
FL9483357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD981502300Medicaid
MD128608Y6FMedicare PIN
P32504Medicare UPIN
MD213420Medicare UPIN