Healthcare Provider Details

I. General information

NPI: 1316755135
Provider Name (Legal Business Name): DAVID SIMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

4956 CARMEL VALLEY DR
KELLER TX
76244-2623
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-3431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number817638
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1189259
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: