Provider Demographics
NPI:1376785972
Name:SIMBULAN, KRISTINE SUSANNE (NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:SUSANNE
Last Name:SIMBULAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 FOX MARSH PL
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1604
Mailing Address - Country:US
Mailing Address - Phone:858-602-9723
Mailing Address - Fax:
Practice Address - Street 1:5500 FOX MARSH PL
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-1604
Practice Address - Country:US
Practice Address - Phone:858-602-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24188418363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health