Provider Demographics
NPI:1679031637
Name:SIMMONS, CYNTHIA (CNA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6729 SE 99TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-6350
Mailing Address - Country:US
Mailing Address - Phone:352-728-5095
Mailing Address - Fax:
Practice Address - Street 1:6729 SE 99TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-6350
Practice Address - Country:US
Practice Address - Phone:352-300-2294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235775372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty