Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 678218 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 678218 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP113959 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 678218 | TX |
NPI | 1205019114 |
---|---|
Provider Name | Roxanne Marie Simcik |
First Address | Dallas, TX 75284-4658 |
Second Address | Belton, TX 76513-8196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 27/10/2020 |