Provider Demographics
NPI:1851096903
Name:SIMS, MELINA CLARISSA
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:CLARISSA
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:CLARISSA
Other - Last Name:LERMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20950 N TATUM BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4204
Mailing Address - Country:US
Mailing Address - Phone:480-222-7246
Mailing Address - Fax:
Practice Address - Street 1:20950 N TATUM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4204
Practice Address - Country:US
Practice Address - Phone:480-222-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ289809363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care