Healthcare Provider Details

I. General information

NPI: 1043788219
Provider Name (Legal Business Name): BOBBIE JEAN SIMS ANCP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BOBBIE SMITH CRNP

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

IV. Provider business mailing address

233 SAINT MICHAELS CIR
ODENTON MD
21113-1074
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6454
  • Fax:
Mailing address:
  • Phone: 859-576-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR172563
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR172563
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: