MEDICARE: MS. MARGARITA F SIMON NP

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	0024061179	VA

General Provider Information

NPI Number	:	1609835594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGARITA F SIMON NP

Provider Business Mailing Address
First Line	:	1446 KEMPSVILLE RD
Second Line	:	STE 204
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7300
Country	:	US
Telephone Number	:	757-474-7460
Fax Number	:	757-474-7455

Provider Business Practice Location Address
First Line	:	1446 KEMPSVILLE RD
Second Line	:	STE 204
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7300
Country	:	US
Telephone Number	:	757-474-7460
Fax Number	:	757-474-7455

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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