Provider Demographics
NPI:1518728542
Name:REDDICK, SIMONE C CHARISSE (RN)
Entity Type:Individual
Prefix:
First Name:SIMONE C
Middle Name:CHARISSE
Last Name:REDDICK
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 1:11407 IVY FLOWER LOOP
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-9473
Mailing Address - Country:US
Mailing Address - Phone:813-712-0663
Mailing Address - Fax:
Practice Address - Street 1:11407 IVY FLOWER LOOP
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-9473
Practice Address - Country:US
Practice Address - Phone:813-712-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9326074163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty