Provider Demographics
NPI:1194390633
Name:SIMMONS, TAMEKA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 RIVER OAKS CIR APT 713
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7921
Mailing Address - Country:US
Mailing Address - Phone:937-830-1331
Mailing Address - Fax:
Practice Address - Street 1:1505 RIVER OAKS CIR APT 713
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7921
Practice Address - Country:US
Practice Address - Phone:937-830-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty