Healthcare Provider Details

I. General information

NPI: 1265736524
Provider Name (Legal Business Name): ALVIN SIMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16233 NE 21ST ST
GAINESVILLE FL
32609-4459
US

IV. Provider business mailing address

16233 NE 21ST ST
GAINESVILLE FL
32609-4459
US

V. Phone/Fax

Practice location:
  • Phone: 352-485-1596
  • Fax: 352-485-1596
Mailing address:
  • Phone: 352-485-1596
  • Fax: 352-485-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberF020764937001
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberF020764937001
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number231584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: