Provider Demographics
NPI:1154309391
Name:SIMONS, AMY C L (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C L
Last Name:SIMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 PLAZA CT N
Mailing Address - Street 2:1 A
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3531
Mailing Address - Country:US
Mailing Address - Phone:303-665-2692
Mailing Address - Fax:303-604-6243
Practice Address - Street 1:1701 W 72ND AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2721
Practice Address - Country:US
Practice Address - Phone:303-650-4460
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO129365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66477336Medicaid
COC418278Medicare ID - Type Unspecified