Healthcare Provider Details

I. General information

NPI: 1184478174
Provider Name (Legal Business Name): CARSIA D SIMMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 UNION ST
VERNON CT
06066-3025
US

IV. Provider business mailing address

119 PINE LN
WINDSOR CT
06095-3500
US

V. Phone/Fax

Practice location:
  • Phone: 860-375-8440
  • Fax:
Mailing address:
  • Phone: 860-690-7698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15727
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: