Provider Demographics
NPI:1942913231
Name:SIMMONS, JENNA DELOVE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:DELOVE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 E 55TH ST # UP
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4840
Mailing Address - Country:US
Mailing Address - Phone:216-512-9963
Mailing Address - Fax:
Practice Address - Street 1:4011 E 55TH ST # UP
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4840
Practice Address - Country:US
Practice Address - Phone:216-512-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183548164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse