Provider Demographics
NPI:1689160376
Name:SIMMONS, SARAH E (CNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 DAL CT NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7755
Mailing Address - Country:US
Mailing Address - Phone:863-812-3421
Mailing Address - Fax:
Practice Address - Street 1:3777 NM HWY 528 NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-7650
Practice Address - Country:US
Practice Address - Phone:505-404-2590
Practice Address - Fax:505-404-2591
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53166363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily