Provider Demographics
NPI:1306179734
Name:SIMMONS-TODD, REBEKAH G (PA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:G
Last Name:SIMMONS-TODD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:G
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12427
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-2427
Mailing Address - Country:US
Mailing Address - Phone:850-297-0114
Mailing Address - Fax:850-297-0314
Practice Address - Street 1:2420 E PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5353
Practice Address - Country:US
Practice Address - Phone:850-701-0621
Practice Address - Fax:850-877-6727
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024923700Medicaid