MEDICARE: MRS. MONIQUE LADONNA SIMMONS APNP

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	363LF0000X	Family Nurse Practitioner	4970-33	WI
2	363LF0000X	Family Nurse Practitioner	AP128039	TX

General Provider Information

NPI Number	:	1700136009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONIQUE LADONNA SIMMONS APNP

Provider Business Mailing Address
First Line	:	936 MEADOW SCAPE DR
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-6999
Country	:	US
Telephone Number	:	608-215-1636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 N COLLINS ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-2802
Country	:	US
Telephone Number	:	682-212-9144
Fax Number	:

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	02/02/2023

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