Provider Demographics
NPI:1063611432
Name:SIMMS, HOLLY D (CRNA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:D
Last Name:SIMMS
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:2 TRAP FALLS ROAD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484
Mailing Address - Country:US
Mailing Address - Phone:203-929-7353
Mailing Address - Fax:203-929-0756
Practice Address - Street 1:99 EAST RIVER DRIVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-7301
Practice Address - Country:US
Practice Address - Phone:860-282-0833
Practice Address - Fax:860-282-0170
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2016-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT071407367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004081725Medicaid
CT004081725Medicaid