Provider Demographics
NPI:1982433561
Name:SIMMONS, BRIAN C (HAS)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5585 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4344
Mailing Address - Country:US
Mailing Address - Phone:850-476-1502
Mailing Address - Fax:850-476-1504
Practice Address - Street 1:5585 STEWART ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4344
Practice Address - Country:US
Practice Address - Phone:850-476-1502
Practice Address - Fax:850-476-1504
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5138237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist