Provider Demographics
NPI:1295183739
Name:SIMPLIDERM, LLC
Entity Type:Organization
Organization Name:SIMPLIDERM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KRAS
Authorized Official - Suffix:III
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-390-9897
Mailing Address - Street 1:3959 VAN DYKE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17907 SPARROWS NEST DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8025
Practice Address - Country:US
Practice Address - Phone:813-390-9896
Practice Address - Fax:813-265-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2721582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty