=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588944912
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YVETTE LAVALLEE SIMS ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2011
-----------------------------------------------------
Last Update Date | 02/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1895 KINGSLEY AVE STE 300
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32073-4453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-276-2549
-----------------------------------------------------
Fax | 904-276-9235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1895 KINGSLEY AVE STE 300
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32073-4453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-276-2549
-----------------------------------------------------
Fax | 904-276-9235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9205013
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9205013
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------