Provider Demographics
NPI:1396822573
Name:SIMONTON, SUSAN O (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:O
Last Name:SIMONTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2500 E LAS OLAS BLVD
Mailing Address - Street 2:#1504
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1508
Mailing Address - Country:US
Mailing Address - Phone:954-527-7829
Mailing Address - Fax:305-558-0570
Practice Address - Street 1:2500 E LAS OLAS BLVD
Practice Address - Street 2:#1504
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1508
Practice Address - Country:US
Practice Address - Phone:954-527-7829
Practice Address - Fax:305-558-0570
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103881363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical