Provider Demographics
NPI:1952631640
Name:SIMMONS, RACHEL SHANALE (ARNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SHANALE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:ARNP
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 1840
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-1840
Mailing Address - Country:US
Mailing Address - Phone:352-504-0340
Mailing Address - Fax:407-354-5425
Practice Address - Street 1:7400 DOCS GROVE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8010
Practice Address - Country:US
Practice Address - Phone:407-352-9717
Practice Address - Fax:407-354-5425
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9276711363LX0001X
FLAPRN9276711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001730700Medicaid
FLDJ496ZMedicare PIN