Provider Demographics
NPI:1407470248
Name:SIMON, VENEL
Entity Type:Individual
Prefix:
First Name:VENEL
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 S CYPRESS RD APT 418
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7032
Mailing Address - Country:US
Mailing Address - Phone:561-305-1567
Mailing Address - Fax:
Practice Address - Street 1:257 S CYPRESS RD APT 418
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7032
Practice Address - Country:US
Practice Address - Phone:561-305-1567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA305408372500000X, 372600000X, 374700000X, 3747A0650X, 3747P1801X, 374U00000X, 376J00000X, 376K00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374700000XNursing Service Related ProvidersTechnician
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106082900Medicaid
FLAHCA235799OtherFLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION
FLCNA305408OtherFLORIDA BOARD OF NURSING
FL106082900Medicaid