Provider Demographics
NPI:1235376591
Name:SIMENSON, JANE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:LOUISE
Last Name:SIMENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:SIMENSON
Other - Last Name:LUKOWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1216 SW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7051
Mailing Address - Country:US
Mailing Address - Phone:239-549-4100
Mailing Address - Fax:
Practice Address - Street 1:1216 SW 50TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-7051
Practice Address - Country:US
Practice Address - Phone:239-549-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine