Healthcare Provider Details

I. General information

NPI: 1043722838
Provider Name (Legal Business Name): CASSANDRA VIRGINIA SIMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 08/06/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S PARSONS AVE STE 9
BRANDON FL
33511-5256
US

IV. Provider business mailing address

PO BOX 963
VALRICO FL
33595-0963
US

V. Phone/Fax

Practice location:
  • Phone: 813-707-0400
  • Fax: 813-322-2362
Mailing address:
  • Phone: 813-810-6844
  • Fax: 813-322-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberRN9425054
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9425054
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberRN9425054
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberRN9425054
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9425054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: