Individual
LATONIA DELORES SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12428 CADLEY CIR, JACKSONVILLE, FL 32219-1861
(904) 802-4363
(904) 713-0632
Mailing address
12428 CADLEY CIR, JACKSONVILLE, FL 32219-1861
(904) 802-4363
(904) 713-0632
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
033051300
FL
253Z00000X
In Home Supportive Care Agency
232816
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003051300
—
FL
Enumeration date
11/06/2013
Last updated
04/28/2016
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