Provider Demographics
NPI:1043722838
Name:SIMPSON, CASSANDRA VIRGINIA (RN)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:VIRGINIA
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33595-0963
Mailing Address - Country:US
Mailing Address - Phone:813-810-6844
Mailing Address - Fax:813-322-2362
Practice Address - Street 1:210 S PARSONS AVE STE 9
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5256
Practice Address - Country:US
Practice Address - Phone:813-707-0400
Practice Address - Fax:813-322-2362
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9425054251E00000X, 163WH0200X, 253Z00000X, 261QD1600X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106270500Medicaid