Provider Demographics
NPI:1417294869
Name:SIMON, ELISA N (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:N
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 44230
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4230
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-398-3998
Practice Address - Street 1:1747 BAPTIST CLAY DR
Practice Address - Street 2:SUITE 350
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8502
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-396-8977
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1267182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIP561YMedicare PIN