MEDICARE: SIMON LAINE ARNP

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	363LF0000X	Family Nurse Practitioner	ARNP9113024	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9313024	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639573157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON LAINE ARNP

Provider Business Mailing Address
First Line	:	5010 HOLLYWOOD BLVD STE 100B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6557
Country	:	US
Telephone Number	:	954-967-0028
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 HOLLYWOOD BLVD STE 100B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6557
Country	:	US
Telephone Number	:	954-967-0028
Fax Number	:

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

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	08/05/2022

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Directions to “ SIMON LAINE ARNP” Practice Location

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