Healthcare Provider Details

I. General information

NPI: 1508240888
Provider Name (Legal Business Name): KADIAN SIMMONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S KANNER HWY STE 200
STUART FL
34994-4801
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-419-4834
  • Fax: 772-344-3890
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07151021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: