Healthcare Provider Details

I. General information

NPI: 1245733450
Provider Name (Legal Business Name): SUZANNE MARIE SIMMONS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE MARIE BRUNSON

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 OCEAN RANCH BLVD STE 208&209
OCEANSIDE CA
92056-2698
US

IV. Provider business mailing address

3609 OCEAN RANCH BLVD STE 208&209
OCEANSIDE CA
92056-2698
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number685563
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95016129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: