Provider Demographics
NPI:1235681370
Name:SIMON, MICAELA AIDA (FNP)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:AIDA
Last Name:SIMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 N 16TH ST STE 120-228
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5512
Mailing Address - Country:US
Mailing Address - Phone:480-332-8446
Mailing Address - Fax:
Practice Address - Street 1:1492 S MILL AVE STE 212
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5664
Practice Address - Country:US
Practice Address - Phone:480-410-4128
Practice Address - Fax:480-410-4130
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN113725163W00000X
AZAP10370207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse