Healthcare Provider Details

I. General information

NPI: 1871116996
Provider Name (Legal Business Name): MARISSA ELIZABETH SIMEONE CORDEIRO APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA ELIZABETH SIMEONE APRN-CNP

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 COUNTY RD STE D
BARRINGTON RI
02806-2430
US

IV. Provider business mailing address

151 SUNRISE DR
BRISTOL RI
02809-5023
US

V. Phone/Fax

Practice location:
  • Phone: 401-247-2288
  • Fax:
Mailing address:
  • Phone: 401-374-3184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02287
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN52453
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: