MEDICARE: LORENZO 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

General Provider Information

NPI Number	:	1730037771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORENZO SIMMONS

Provider Business Mailing Address
First Line	:	10284 FALCON GATE LOOP APT 304
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5820
Country	:	US
Telephone Number	:	863-253-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	10284 FALCON GATE LOOP APT 304
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5820
Country	:	US
Telephone Number	:	863-253-1798
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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