Provider Demographics
NPI:1588852982
Name:SIMONETTA, CHRISTINE ELAINE (LM)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ELAINE
Last Name:SIMONETTA
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MARKLEY CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4044
Mailing Address - Country:US
Mailing Address - Phone:321-544-8991
Mailing Address - Fax:321-254-3708
Practice Address - Street 1:1372 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6519
Practice Address - Country:US
Practice Address - Phone:321-254-3808
Practice Address - Fax:321-254-3708
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW207176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife