Healthcare Provider Details

I. General information

NPI: 1487139077
Provider Name (Legal Business Name): SYDNEE PRINCE SIMPSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W GANDY BLVD
TAMPA FL
33611-2931
US

IV. Provider business mailing address

10051 NEW PARKE RD
TAMPA FL
33626-5415
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-1903
  • Fax: 813-749-8370
Mailing address:
  • Phone: 727-871-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111595
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9111595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: