Healthcare Provider Details

I. General information

NPI: 1245096585
Provider Name (Legal Business Name): JAMIRAH A SIMMONS PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COMMONWEALTH PL STE 200
VIRGINIA BEACH VA
23464-4530
US

IV. Provider business mailing address

900 COMMONWEALTH PL STE 200
VIRGINIA BEACH VA
23464-4530
US

V. Phone/Fax

Practice location:
  • Phone: 757-737-5163
  • Fax: 767-937-2763
Mailing address:
  • Phone: 757-737-5163
  • Fax: 767-937-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberM4F3C2W3
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: