MEDICARE: BRENDON SIMMER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN9443513	FL
2	367500000X	Certified Registered Nurse Anesthetist	APRN11026438	FL

General Provider Information

NPI Number	:	1255031175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDON SIMMER CRNA

Provider Business Mailing Address
First Line	:	1900 PINE ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-2432
Country	:	US
Telephone Number	:	954-253-4279
Fax Number	:

Provider Business Practice Location Address
First Line	:	5216 NE 5TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33334-2444
Country	:	US
Telephone Number	:	954-253-4279
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	06/18/2024

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