Provider Demographics
NPI:1497058879
Name:SIMMONS BECIL, BETHANIE M (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANIE
Middle Name:M
Last Name:SIMMONS BECIL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MRS
Other - First Name:BETHANIE
Other - Middle Name:M
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:3333 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-1703
Mailing Address - Country:US
Mailing Address - Phone:904-695-9145
Mailing Address - Fax:
Practice Address - Street 1:3333 W 20TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-1703
Practice Address - Country:US
Practice Address - Phone:904-695-9145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLAPRN9263008363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9263008OtherADVANCED PRACTICE REGISTERED NURSE
VA0024170939OtherLICENSED NURSE PRACTITIONER