Provider Demographics
NPI:1881199149
Name:SIMMONS, ANNICE (RN)
Entity Type:Individual
Prefix:
First Name:ANNICE
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 MAJESTIC PALM CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-9435
Mailing Address - Country:US
Mailing Address - Phone:813-466-8793
Mailing Address - Fax:
Practice Address - Street 1:10120 MAJESTIC PALM CIR APT 202
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-9435
Practice Address - Country:US
Practice Address - Phone:813-466-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9411162163W00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator