MEDICARE: ROXANNE MARIE SIMCIK FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	678218	TX
2	363LF0000X	Family Nurse Practitioner	678218	TX
3	363LN0005X	Critical Care Neonatal Nurse Practitioner	678218	TX
4	363LF0000X	Family Nurse Practitioner	AP113959	TX

General Provider Information

NPI Number	:	1205019114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE MARIE SIMCIK FNP

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 ARBOR PARK
Second Line	:
City	:	BELTON
State	:	TX
Zip	:	76513-8196
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	10/27/2020

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