Healthcare Provider Details

I. General information

NPI: 1144202383
Provider Name (Legal Business Name): SIMONE H BRADY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 OLD DOBBIN LN
COLUMBIA MD
21045-5816
US

IV. Provider business mailing address

309 EAGLE BAY LN BAY
SANTA ROSA BEACH FL
32459-8377
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-3399
  • Fax:
Mailing address:
  • Phone: 443-789-1818
  • Fax: 850-534-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number3268080889
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR115117
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9483357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: