Provider Demographics
NPI:1528391307
Name:JOHN, CIMONE S (NP)
Entity Type:Individual
Prefix:
First Name:CIMONE
Middle Name:S
Last Name:JOHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 MEADOW GROVE TRL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6685
Mailing Address - Country:US
Mailing Address - Phone:757-627-0241
Mailing Address - Fax:757-622-8898
Practice Address - Street 1:2810 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1050
Practice Address - Country:US
Practice Address - Phone:757-627-0241
Practice Address - Fax:757-622-8898
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001178380363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024168407OtherLICENSE