Provider Demographics
NPI:1154629814
Name:SIMMONS, JENNILYN ALEXIS (MSN,FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNILYN
Middle Name:ALEXIS
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSN,FNP-C
Other - Prefix:
Other - First Name:JENNILYN
Other - Middle Name:ALEXIS
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,FNP-C
Mailing Address - Street 1:3000 SHAKERAG HL
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3365
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 SHAKERAG HL
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3365
Practice Address - Country:US
Practice Address - Phone:404-251-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235628363LF0000X
TNAPN15669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522882Medicaid