Healthcare Provider Details

I. General information

NPI: 1720539018
Provider Name (Legal Business Name): WANDA SIMMONS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4974 HIGBEE AVE NW STE 103
CANTON OH
44718-2562
US

IV. Provider business mailing address

1032 E BRANDON BLVD STE 4567
BRANDON FL
33511-5509
US

V. Phone/Fax

Practice location:
  • Phone: 330-933-4691
  • Fax: 855-873-7557
Mailing address:
  • Phone: 201-474-5844
  • Fax: 807-804-1324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP019767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: