Provider Demographics
NPI:1952968026
Name:SIMO, JOSE MIGUEL (ARNP)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MIGUEL
Last Name:SIMO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12724 SHORELINE DR.
Mailing Address - Street 2:UNIT E
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-714-5070
Mailing Address - Fax:
Practice Address - Street 1:3347 S STATE ROAD 7 STE 205
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8148
Practice Address - Country:US
Practice Address - Phone:561-793-6100
Practice Address - Fax:561-793-1974
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000244207RC0000X
FLAPRN11000244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease