Healthcare Provider Details

I. General information

NPI: 1235681370
Provider Name (Legal Business Name): MICAELA AIDA SIMON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 S MILL AVE STE 212
TEMPE AZ
85281-5664
US

IV. Provider business mailing address

7000 N 16TH ST STE 120-228
PHOENIX AZ
85020-5512
US

V. Phone/Fax

Practice location:
  • Phone: 480-410-4128
  • Fax: 480-410-4130
Mailing address:
  • Phone: 480-332-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN113725
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAP10370
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: