Healthcare Provider Details

I. General information

NPI: 1871210989
Provider Name (Legal Business Name): TIA SIMONE HOBBS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 SUN N LAKE BLVD STE 102
SEBRING FL
33872-2171
US

IV. Provider business mailing address

130 MEDICAL CENTER AVE
SEBRING FL
33870-5463
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-1663
  • Fax: 863-386-0162
Mailing address:
  • Phone: 863-385-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN9368231
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11022639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: