MEDICARE: LATASHA L SIMMONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center		FL

General Provider Information

NPI Number	:	1184198772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASHA L SIMMONS

Provider Business Mailing Address
First Line	:	2462 13TH AVE N APT 308
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-5855
Country	:	US
Telephone Number	:	181-340-1535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2462 13TH AVE N APT 308
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-5855
Country	:	US
Telephone Number	:	813-401-5356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	12/15/2025

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