Healthcare Provider Details

I. General information

NPI: 1780871665
Provider Name (Legal Business Name): SIMONA NICHITA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIMONA TUDOSE MD

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W UNIVERSITY DR
PROSPER TX
75078-9806
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 682-303-8000
  • Fax: 682-303-8002
Mailing address:
  • Phone: 682-885-1860
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41214
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: