Provider Demographics
NPI:1659738318
Name:SIMON-CANELLAS, YUDITH (FNP)
Entity Type:Individual
Prefix:
First Name:YUDITH
Middle Name:
Last Name:SIMON-CANELLAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SE 5TH CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2019
Mailing Address - Country:US
Mailing Address - Phone:305-803-4502
Mailing Address - Fax:
Practice Address - Street 1:1325 SE 47TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9692
Practice Address - Country:US
Practice Address - Phone:239-205-2337
Practice Address - Fax:239-310-5287
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9400138364SF0001X
FLAPRN9400138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health