Provider Demographics
NPI:1457993156
Name:PARMENTER, SIMONE KAYLA (FNP)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:KAYLA
Last Name:PARMENTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21207 SAILORS BAY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-6949
Mailing Address - Country:US
Mailing Address - Phone:714-345-0403
Mailing Address - Fax:
Practice Address - Street 1:1100 S COAST HWY STE 212
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2975
Practice Address - Country:US
Practice Address - Phone:949-632-8087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily