Provider Demographics
NPI:1558797100
Name:SIMKUS, JOANNA GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:GRACE
Last Name:SIMKUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:GRACE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7575 NORTHCLIFF AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3266
Mailing Address - Country:US
Mailing Address - Phone:216-539-2702
Mailing Address - Fax:
Practice Address - Street 1:7575 NORTHCLIFF AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-3267
Practice Address - Country:US
Practice Address - Phone:216-539-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant