Provider Demographics
NPI:1225412844
Name:SIMON, TAMIQUIA (EDD)
Entity Type:Individual
Prefix:DR
First Name:TAMIQUIA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 FRANCIS MARION RD
Mailing Address - Street 2:
Mailing Address - City:PAMPLICO
Mailing Address - State:SC
Mailing Address - Zip Code:29583-6902
Mailing Address - Country:US
Mailing Address - Phone:843-616-4225
Mailing Address - Fax:
Practice Address - Street 1:928 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:PAMPLICO
Practice Address - State:SC
Practice Address - Zip Code:29583-6810
Practice Address - Country:US
Practice Address - Phone:843-616-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator