Healthcare Provider Details

I. General information

NPI: 1740503622
Provider Name (Legal Business Name): CHERYL SIMMONS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S VAL VISTA DR SUITE 138 BLD 7
GILBERT AZ
85295-1675
US

IV. Provider business mailing address

2730 S VAL VISTA DR SUITE 138 BLD 7
GILBERT AZ
85295-1675
US

V. Phone/Fax

Practice location:
  • Phone: 480-686-9686
  • Fax: 480-686-9508
Mailing address:
  • Phone: 480-686-9686
  • Fax: 480-686-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3582
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: