Provider Demographics
NPI:1689688830
Name:SIMS-ROBERTSON, CAROL JEANNE (MD)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JEANNE
Last Name:SIMS-ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:JEANNE
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2100 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:DIVINE DERMATOLOGY PLLC
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3264
Mailing Address - Country:US
Mailing Address - Phone:727-528-0321
Mailing Address - Fax:727-498-6632
Practice Address - Street 1:2100 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:DIVINE DERMATOLOGY PLLC
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3264
Practice Address - Country:US
Practice Address - Phone:727-528-0321
Practice Address - Fax:727-498-6632
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87149207N00000X
MI431047892207N00000X
CAG65165207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBS9296129OtherDEA
MIBS6644555OtherDEA
A73651Medicare UPIN
FLBS9296129OtherDEA
MIBS6644555OtherDEA