Provider Demographics
NPI:1417495045
Name:SIMMONS, STACEY M (RNFA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 ASHWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-7581
Mailing Address - Country:US
Mailing Address - Phone:720-775-8088
Mailing Address - Fax:
Practice Address - Street 1:3368 ASHWORTH AVE
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-7581
Practice Address - Country:US
Practice Address - Phone:720-775-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0195130163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant