Healthcare Provider Details

I. General information

NPI: 1003092610
Provider Name (Legal Business Name): MRS. NIKKI G SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 LAS CRUCES DR
WINTER SPRINGS FL
32708-4843
US

IV. Provider business mailing address

1219 LAS CRUCES DR
WINTER SPRINGS FL
32708-4843
US

V. Phone/Fax

Practice location:
  • Phone: 407-222-2115
  • Fax: 407-695-8329
Mailing address:
  • Phone: 407-222-2115
  • Fax: 407-695-8329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number075318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: