Healthcare Provider Details

I. General information

NPI: 1730701830
Provider Name (Legal Business Name): SHAKANA LASHEA SIMMONS-HALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 JAKE CT
OCOEE FL
34761-4418
US

IV. Provider business mailing address

13750 W. COLONIAL DRIVE SUITE 350 #247
WINTER GARDEN FL
34787
US

V. Phone/Fax

Practice location:
  • Phone: 407-803-3706
  • Fax:
Mailing address:
  • Phone: 407-803-3706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG01200157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: