Provider Demographics
NPI:1922393164
Name:SIMPSON, ANTENET NICHELLE (CNA)
Entity Type:Individual
Prefix:
First Name:ANTENET
Middle Name:NICHELLE
Last Name:SIMPSON
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 1:127 MANOUS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8713
Mailing Address - Country:US
Mailing Address - Phone:904-735-4083
Mailing Address - Fax:678-880-9460
Practice Address - Street 1:127 MANOUS DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30115-8713
Practice Address - Country:US
Practice Address - Phone:904-735-4083
Practice Address - Fax:678-880-9460
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028908067376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide