Provider Demographics
NPI:1285326926
Name:SIMMONS, TARAH NICHOLE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TARAH
Middle Name:NICHOLE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:TARAH
Other - Middle Name:NICHOLE
Other - Last Name:DOBISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:137 CONNIE BEE LN
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-5854
Mailing Address - Country:US
Mailing Address - Phone:843-539-6711
Mailing Address - Fax:
Practice Address - Street 1:501 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2787
Practice Address - Country:US
Practice Address - Phone:843-782-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily