Individual
PORCHE SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3239 SPICER AVE, GRAND ISLAND, FL 32735-9018
(352) 901-3619
Mailing address
2818 KINSLEY ST, LAKELAND, FL 33812-3814
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
755638
—
FL
Enumeration date
04/15/2022
Last updated
04/15/2022
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