Provider Demographics
NPI:1962959346
Name:SIMON, PAULINA (AGPCNP)
Entity type:Individual
Prefix:
First Name:PAULINA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 W EMILE ZOLA AVE
Mailing Address - Street 2:#5178
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3068
Mailing Address - Country:US
Mailing Address - Phone:623-219-7768
Mailing Address - Fax:480-436-6926
Practice Address - Street 1:14074 N 90TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3678
Practice Address - Country:US
Practice Address - Phone:623-219-7768
Practice Address - Fax:480-436-6926
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8849363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology