Provider Demographics
NPI:1053553974
Name:SIMON, KIMBERLY (APRN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746649
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6649
Mailing Address - Country:US
Mailing Address - Phone:904-376-4400
Mailing Address - Fax:904-391-5595
Practice Address - Street 1:2310 VILLAGE SQUARE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6351
Practice Address - Country:US
Practice Address - Phone:904-516-1880
Practice Address - Fax:904-516-1885
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9263507363LF0000X, 363L00000X
FLARNP9263507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily