Provider Demographics
NPI:1316386931
Name:SIMMONS, LISA JANE (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JANE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ROBERT ROSE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-6365
Mailing Address - Country:US
Mailing Address - Phone:615-225-9100
Mailing Address - Fax:
Practice Address - Street 1:210 ROBERT ROSE DR STE B
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-6365
Practice Address - Country:US
Practice Address - Phone:615-225-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904357363L00000X
TN17444363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner