Provider Demographics
NPI:1588910830
Name:SIMON, CAMILLA N (APRN)
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:N
Last Name:SIMON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 KAPIOLANI BLVD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5212
Mailing Address - Country:US
Mailing Address - Phone:808-597-8799
Mailing Address - Fax:
Practice Address - Street 1:770 KAPIOLANI BLVD STE 705
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5241
Practice Address - Country:US
Practice Address - Phone:808-597-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001410363L00000X
NVAPRN001410363L00000X
FLAPRN11020157363LF0000X
HIAPRN-4895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner