Healthcare Provider Details

I. General information

NPI: 1265167845
Provider Name (Legal Business Name): CHARIS SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 ATLANTIC BLVD
JACKSONVILLE FL
32225-0103
US

IV. Provider business mailing address

5350 ARLINGTON EXPY APT 504
JACKSONVILLE FL
32211-6822
US

V. Phone/Fax

Practice location:
  • Phone: 904-491-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: