Provider Demographics
NPI:1194152264
Name:HOLDEN, SIMONE F (PA)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:F
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SIMONE
Other - Middle Name:
Other - Last Name:YOUSSEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4304
Mailing Address - Fax:
Practice Address - Street 1:219 N BROAD ST FL 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1507
Practice Address - Country:US
Practice Address - Phone:215-762-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant