Provider Demographics
NPI:1912140450
Name:SIMMONS, NATALIE RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:RENEE
Last Name:SIMMONS
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 1:145 DAYDREAM AVE APT 4108
Mailing Address - Street 2:
Mailing Address - City:WILDLIGHT
Mailing Address - State:FL
Mailing Address - Zip Code:32097-5465
Mailing Address - Country:US
Mailing Address - Phone:904-518-1025
Mailing Address - Fax:
Practice Address - Street 1:145 DAYDREAM AVE APT 4108
Practice Address - Street 2:
Practice Address - City:WILDLIGHT
Practice Address - State:FL
Practice Address - Zip Code:32097-5465
Practice Address - Country:US
Practice Address - Phone:904-518-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012576702085R0202X
SC521402085R0202X
CT0506722085R0202X
NC2015-006032085R0202X
FLME1433232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology