Healthcare Provider Details

I. General information

NPI: 1366953143
Provider Name (Legal Business Name): AMY SIMMONS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 E SOUTHERN AVE STE 106
MESA AZ
85204-5058
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 480-870-7400
  • Fax: 480-906-2174
Mailing address:
  • Phone: 888-987-1151
  • Fax: 480-304-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10607
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: