Provider Demographics
NPI:1497090351
Name:SIMMONS, MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 S POINTE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4901
Mailing Address - Country:US
Mailing Address - Phone:239-275-0040
Mailing Address - Fax:239-275-4273
Practice Address - Street 1:6311 S POINTE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4901
Practice Address - Country:US
Practice Address - Phone:239-275-0040
Practice Address - Fax:239-275-4273
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106990363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical