Provider Demographics
NPI:1104499094
Name:SIMMS, PETA-GAYE (CRNA)
Entity type:Individual
Prefix:
First Name:PETA-GAYE
Middle Name:
Last Name:SIMMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MIX AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-5106
Mailing Address - Country:US
Mailing Address - Phone:347-571-3579
Mailing Address - Fax:
Practice Address - Street 1:1073 N BENSON RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5171
Practice Address - Country:US
Practice Address - Phone:347-571-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT178848163WC0200X
CT149052367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine