Provider Demographics
NPI:1134192362
Name:LOWERY, SIMONE MUKNICKA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:MUKNICKA
Last Name:LOWERY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20023 TAMIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3368
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-862-2752
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-862-2752
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9103125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant