Provider Demographics
NPI:1225559099
Name:SIMMONS, SHAQUILLA (RN)
Entity Type:Individual
Prefix:
First Name:SHAQUILLA
Middle Name:
Last Name:SIMMONS
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 75
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-0060
Mailing Address - Country:US
Mailing Address - Phone:856-558-5627
Mailing Address - Fax:
Practice Address - Street 1:987 DELSEA DR
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08322-2313
Practice Address - Country:US
Practice Address - Phone:856-694-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN689236163W00000X
NJ26NR19061900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse