Provider Demographics
NPI:1578924353
Name:MARILYN SIMEON PENA
Entity Type:Organization
Organization Name:MARILYN SIMEON PENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMEON PENA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-879-3530
Mailing Address - Street 1:4506 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2732
Mailing Address - Country:US
Mailing Address - Phone:813-879-3530
Mailing Address - Fax:813-874-6608
Practice Address - Street 1:4506 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2732
Practice Address - Country:US
Practice Address - Phone:813-879-3530
Practice Address - Fax:813-874-6608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9288272363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty