Provider Demographics
NPI:1285179531
Name:SIMMONS, LISAMARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:LISAMARIE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4173 SW WINSLOW ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7240
Mailing Address - Country:US
Mailing Address - Phone:203-809-8950
Mailing Address - Fax:
Practice Address - Street 1:1900 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-466-4200
Practice Address - Fax:772-466-9513
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9296268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily