Provider Demographics
NPI:1417314105
Name:FANNINGS, SIMONSEA B (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SIMONSEA
Middle Name:B
Last Name:FANNINGS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MADISON AVE APT A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23604-1124
Mailing Address - Country:US
Mailing Address - Phone:972-897-5010
Mailing Address - Fax:
Practice Address - Street 1:13000 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8340
Practice Address - Country:US
Practice Address - Phone:757-269-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily