Healthcare Provider Details

I. General information

NPI: 1649184763
Provider Name (Legal Business Name): NINA SIMONE EXIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 BEACONS WAY HAMPTON HARBOR, APARTMENT 26A
HAMPTON VA
23669
US

IV. Provider business mailing address

26 BEACONS WAY HAMPTON HARBOR, APARTMENT 26A
HAMPTON VA
23669
US

V. Phone/Fax

Practice location:
  • Phone: 908-296-4207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: