Provider Demographics
NPI:1598223026
Name:SIMMONS, JASMINE M
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MANAYUNK
Mailing Address - State:PA
Mailing Address - Zip Code:19127-2027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 CAMPUS BLVD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3245
Practice Address - Country:US
Practice Address - Phone:267-809-4397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA40033601Medicaid