Healthcare Provider Details

I. General information

NPI: 1639069552
Provider Name (Legal Business Name): RENATA SIMONAITYTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/24/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S KANNER HWY
STUART FL
34994-7204
US

IV. Provider business mailing address

3945 SW BIMINI CIR S
PALM CITY FL
34990-1340
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-2992
  • Fax:
Mailing address:
  • Phone: 772-626-3258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: