Provider Demographics
NPI:1366823833
Name:WARNER, SIMON MARK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:MARK
Last Name:WARNER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:14050 NW 14TH STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2851
Mailing Address - Country:US
Mailing Address - Phone:800-424-3672
Mailing Address - Fax:954-377-3042
Practice Address - Street 1:206 2ND ST E
Practice Address - Street 2:ER DEPT
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1042
Practice Address - Country:US
Practice Address - Phone:941-746-5111
Practice Address - Fax:954-377-3042
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant