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General NPI Number Information
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NPI Number | 1134598857
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Entity Type | Individual
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Provider Name | SHAVONE SIMMONDS PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 1887 KINGSLEY AVE SUITE 1900
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City | ORANGE PARK
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State | FL
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Zip | 32073-4416
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Country | US
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Telephone | 904-272-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 TOUCHTON RD APT. #638
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City | JACKSONVILLE
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State | FL
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Zip | 32246-8296
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Country | US
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Telephone | 571-521-9811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA 9108356
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License Number State | FL
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