Provider Demographics
NPI:1689098287
Name:SIMICA-FAZENDIN, ANNA NARIE (RN,MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:NARIE
Last Name:SIMICA-FAZENDIN
Suffix:
Gender:F
Credentials:RN,MSN, FNP-C
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:SIMICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN APRN
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763
Mailing Address - Country:US
Mailing Address - Phone:229-272-8648
Mailing Address - Fax:
Practice Address - Street 1:347 MIDDLE RD N UNIT H
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-3766
Practice Address - Country:US
Practice Address - Phone:229-272-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF2014185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily