Individual
TANISHA ANN SIMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
614 E CALLE CHULO RD, GOODYEAR, AZ 85338-1006
(219) 290-6662
Mailing address
614 E CALLE CHULO RD, GOODYEAR, AZ 85338-1006
(219) 290-6662
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
21619565
IN
3747P1801X
Personal Care Attendant
21619565
AZ
Other
Enumeration date
08/25/2025
Last updated
08/25/2025
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