Individual
JERRY GORDON SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3314 HENDERSON BLVD STE 100E, TAMPA, FL 33609-2999
(813) 391-5909
(813) 864-6741
Mailing address
3314 HENDERSON BLVD STE 100E, TAMPA, FL 33609-2999
(813) 391-5909
(813) 864-6741
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104946200
—
FL
Enumeration date
01/25/2021
Last updated
01/25/2021
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