Provider Demographics
NPI:1851696132
Name:SIMPLY WOMEN PL
Entity Type:Organization
Organization Name:SIMPLY WOMEN PL
Other - Org Name:SIMPLY WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARDOSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-644-4496
Mailing Address - Street 1:PO BOX 6175
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33807-6175
Mailing Address - Country:US
Mailing Address - Phone:863-644-4496
Mailing Address - Fax:863-644-4497
Practice Address - Street 1:619 MIDFLORIDA DR
Practice Address - Street 2:SUITE 3
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4902
Practice Address - Country:US
Practice Address - Phone:863-644-4496
Practice Address - Fax:863-644-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 81562261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty