Provider Demographics
NPI:1598543902
Name:SIMMONS, ANGELICA NESBITT
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:NESBITT
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:PO BOX 1524
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29449-1524
Mailing Address - Country:US
Mailing Address - Phone:843-603-0219
Mailing Address - Fax:
Practice Address - Street 1:4939 BAPTIST HILL RD
Practice Address - Street 2:
Practice Address - City:YONGES ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29449-6903
Practice Address - Country:US
Practice Address - Phone:843-603-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker