Healthcare Provider Details

I. General information

NPI: 1962044354
Provider Name (Legal Business Name): COURTNEY MARIE SIMMONS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WESTMORELAND DR
ORLANDO FL
32805-2258
US

IV. Provider business mailing address

101 S WESTMORELAND DR
ORLANDO FL
32805-2258
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-3688
  • Fax:
Mailing address:
  • Phone: 407-821-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11015863
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9411261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: