Healthcare Provider Details

I. General information

NPI: 1093164667
Provider Name (Legal Business Name): JARED T SIMMONS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 S HWY 27 STE 105
CLERMONT FL
34711
US

IV. Provider business mailing address

1450 6TH ST SE
WINTER HAVEN FL
33880-4505
US

V. Phone/Fax

Practice location:
  • Phone: 855-353-7546
  • Fax: 863-293-2147
Mailing address:
  • Phone: 863-293-2147
  • Fax: 863-294-2767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9343190
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9343190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: