Provider Demographics
NPI:1669294021
Name:SIMMONS, ROBERTA H
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:H
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 1:713 1ST NE
Mailing Address - Street 2:
Mailing Address - City:HAVAVA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-1405
Mailing Address - Country:US
Mailing Address - Phone:850-567-3056
Mailing Address - Fax:
Practice Address - Street 1:713 NE 1ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-1405
Practice Address - Country:US
Practice Address - Phone:850-567-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider