MEDICARE: MRS. GINA NICOLE SIMPSON RMA (AAH), PTC, ETC

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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1528841624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA NICOLE SIMPSON RMA (AAH), PTC, ETC

Provider Business Mailing Address
First Line	:	6507 MISSION SPRINGS LN
Second Line	:
City	:	CORRYTON
State	:	TN
Zip	:	37721-3974
Country	:	US
Telephone Number	:	865-661-6993
Fax Number	:	650-542-3886

Provider Business Practice Location Address
First Line	:	6507 MISSION SPRINGS LN
Second Line	:
City	:	CORRYTON
State	:	TN
Zip	:	37721-3974
Country	:	US
Telephone Number	:	865-661-6993
Fax Number	:	650-542-3886

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

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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