Provider Demographics
NPI:1467557157
Name:SIMONSON, KATHLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 S HEALTHPARK DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7603
Mailing Address - Country:US
Mailing Address - Phone:239-433-6760
Mailing Address - Fax:239-433-6766
Practice Address - Street 1:2295 VICTORIA AVE
Practice Address - Street 2:ROOM 112
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3884
Practice Address - Country:US
Practice Address - Phone:239-337-1675
Practice Address - Fax:239-338-1506
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2982792163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management