Provider Demographics
NPI:1558060129
Name:REYES, SIMONE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:SIMONE
Other - Middle Name:
Other - Last Name:SITCHERAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2548 STAPLEFORD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 BEACH BLVD STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4303
Practice Address - Country:US
Practice Address - Phone:904-241-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily