Provider Demographics
NPI:1154869527
Name:SIMMONS, GREGORY (ARNP-C)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 SW 1ST AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8101
Mailing Address - Country:US
Mailing Address - Phone:352-409-2110
Mailing Address - Fax:
Practice Address - Street 1:1834 SW 1ST AVE
Practice Address - Street 2:STE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8101
Practice Address - Country:US
Practice Address - Phone:352-732-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9179262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019959500Medicaid
FL019959500Medicaid