Provider Demographics
NPI:1649094970
Name:ANCKLE, SIMONE BRIDGETT (APN)
Entity type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:BRIDGETT
Last Name:ANCKLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:SIMONE
Other - Middle Name:BRIDGETT
Other - Last Name:ANCKLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:23 LARAMIE RD
Mailing Address - Street 2:PLAINFIELD
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060
Mailing Address - Country:US
Mailing Address - Phone:908-294-1451
Mailing Address - Fax:
Practice Address - Street 1:23 LARAMIE RD
Practice Address - Street 2:PLAINFIELD
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060
Practice Address - Country:US
Practice Address - Phone:908-294-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15082200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily