Provider Demographics
NPI:1063951572
Name:SIMON, STACEY RENEE (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:RENEE
Last Name:SIMON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:RENEE
Other - Last Name:SPICER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:4040 EMBASSY PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-8326
Mailing Address - Country:US
Mailing Address - Phone:330-576-4295
Mailing Address - Fax:330-576-0468
Practice Address - Street 1:4040 EMBASSY PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8326
Practice Address - Country:US
Practice Address - Phone:330-576-4295
Practice Address - Fax:330-576-0468
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily