Provider Demographics
NPI:1659766830
Name:SIMONS, CAROLINE HEYWARD (RN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:HEYWARD
Last Name:SIMONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 BAYTREE CT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3534
Mailing Address - Country:US
Mailing Address - Phone:843-714-0241
Mailing Address - Fax:
Practice Address - Street 1:8450 GATE PKWY W UNIT 1007
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1077
Practice Address - Country:US
Practice Address - Phone:843-714-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87618163WP2201X
WY6759163WP2201X
NVRN80335163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care