Provider Demographics
NPI:1972119196
Name:SIMMONS, ROBIN (GROUP HOME)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:GROUP HOME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 27TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-3438
Mailing Address - Country:US
Mailing Address - Phone:727-259-8446
Mailing Address - Fax:
Practice Address - Street 1:1401 27TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3438
Practice Address - Country:US
Practice Address - Phone:727-259-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities