Provider Demographics
NPI:1144730565
Name:STEWART, SIMONE ODETTA (AANP)
Entity type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:ODETTA
Last Name:STEWART
Suffix:
Gender:F
Credentials:AANP
Other - Prefix:MRS
Other - First Name:SIMONE
Other - Middle Name:ODETTA
Other - Last Name:JOHN BAPTISTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AANP
Mailing Address - Street 1:345 JUPITER LAKES BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7100
Mailing Address - Country:US
Mailing Address - Phone:954-263-2248
Mailing Address - Fax:561-423-5883
Practice Address - Street 1:345 JUPITER LAKES BLVD STE 200
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7100
Practice Address - Country:US
Practice Address - Phone:561-741-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3177382163WX0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, InpatientGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1144730565OtherAANP
FL1144730565Medicaid