Healthcare Provider Details

I. General information

NPI: 1851096903
Provider Name (Legal Business Name): MELINA CLARISSA SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELINA CLARISSA LERMA

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14749 W MOUNTAIN VIEW BLVD STE 138
SURPRISE AZ
85374-2704
US

IV. Provider business mailing address

14749 W MOUNTAIN VIEW BLVD STE 138
SURPRISE AZ
85374-2704
US

V. Phone/Fax

Practice location:
  • Phone: 623-738-0440
  • Fax: 480-374-8051
Mailing address:
  • Phone: 623-738-0440
  • Fax: 480-374-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number289809
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number289809
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: