Provider Demographics
NPI:1336169960
Name:SIMMONS, STEVEN CHRISTOPHER (CRNP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CHRISTOPHER
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 COUNTRY WALK DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8614
Mailing Address - Country:US
Mailing Address - Phone:443-896-6295
Mailing Address - Fax:904-282-4117
Practice Address - Street 1:400 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-4120
Practice Address - Country:US
Practice Address - Phone:443-896-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR148994363LF0000X
FLARNP9181717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00285741OtherMEDICARE RAILROAD
FL304523400Medicaid
FL304523400Medicaid
FLP00285741OtherMEDICARE RAILROAD