Provider Demographics
NPI:1922075134
Name:NADER, SIMONE (MD)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:NADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-720-0599
Mailing Address - Fax:904-376-4036
Practice Address - Street 1:14534 OLD SAINT AUGUSTINE RD STE 3420
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2616
Practice Address - Country:US
Practice Address - Phone:904-493-8001
Practice Address - Fax:904-338-0852
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79875207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01132904OtherRR MEDICARE
FL008024700Medicaid
FL008024700Medicaid
OH4023583Medicare PIN
0119204OtherGROUP MEDICAID
10796600OtherCAQH
FL008024700Medicaid
D368301OtherGROUP IND DIAGNOSTICS MED
1780634279OtherGROUP NPI
107753OtherKAISER
CA4511OtherGROUP RR MEDICARE
3610861OtherGROUP ASC MEDICARE