Provider Demographics
NPI:1740559087
Name:SIMMONS BROWN, MICHELLE ANN (JD ADS AP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:SIMMONS BROWN
Suffix:
Gender:F
Credentials:JD ADS AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16517 VANDERBILT DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7550
Mailing Address - Country:US
Mailing Address - Phone:239-947-6234
Mailing Address - Fax:
Practice Address - Street 1:16517 VANDERBILT DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7550
Practice Address - Country:US
Practice Address - Phone:239-947-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP-3022171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist