Healthcare Provider Details

I. General information

NPI: 1841936713
Provider Name (Legal Business Name): LUCAS SIMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2785 S BAY ST STE A
EUSTIS FL
32726-6591
US

IV. Provider business mailing address

36439 PINEY RIDGE BLVD
FRUITLAND PARK FL
34731-5383
US

V. Phone/Fax

Practice location:
  • Phone: 844-668-6222
  • Fax: 888-975-0599
Mailing address:
  • Phone: 352-272-3075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-232020
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-83856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: