Provider Demographics
NPI:1043866965
Name:FAIN, JAMILA SIMMONS
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:SIMMONS
Last Name:FAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 JACKSON BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-4148
Mailing Address - Country:US
Mailing Address - Phone:850-274-1295
Mailing Address - Fax:
Practice Address - Street 1:1839 JACKSON BLUFF RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-4148
Practice Address - Country:US
Practice Address - Phone:850-274-1295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care