Healthcare Provider Details

I. General information

NPI: 1821924416
Provider Name (Legal Business Name): MS. ERICA J SIMMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 NW CENTRAL PARK PLZ
PORT SAINT LUCIE FL
34986-2482
US

IV. Provider business mailing address

1602 SW BELLEVUE AVE
PORT SAINT LUCIE FL
34953-1103
US

V. Phone/Fax

Practice location:
  • Phone: 772-303-1987
  • Fax:
Mailing address:
  • Phone: 772-828-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number28628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: