Provider Demographics
NPI:1578235487
Name:SIMON, REBECCA (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 REMINGTON CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8199
Mailing Address - Country:US
Mailing Address - Phone:903-413-4503
Mailing Address - Fax:
Practice Address - Street 1:1289 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-1559
Practice Address - Country:US
Practice Address - Phone:979-326-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily