Provider Demographics
NPI:1982140752
Name:SIMMONS, TAMERA
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 82ND AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-6990
Mailing Address - Country:US
Mailing Address - Phone:772-492-9841
Mailing Address - Fax:772-492-9846
Practice Address - Street 1:1910 82ND AVE
Practice Address - Street 2:STE 102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-6990
Practice Address - Country:US
Practice Address - Phone:772-492-9841
Practice Address - Fax:772-492-9846
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker