MEDICARE: MARY 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	372600000X	Adult Companion
2	376J00000X	Homemaker
3	376K00000X	Nurse's Aide	393792	FL
4	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1982404794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SIMMONS

Provider Business Mailing Address
First Line	:	1540 OAKHURST AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3239
Country	:	US
Telephone Number	:	904-414-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 OAKHURST AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3239
Country	:	US
Telephone Number	:	904-414-0447
Fax Number	:

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

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

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Directions to “ MARY SIMMONS ” Practice Location

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