Provider Demographics
NPI:1437453362
Name:SIMPKINS, PHYLLIS FELECIA
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:FELECIA
Last Name:SIMPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82831
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2831
Mailing Address - Country:US
Mailing Address - Phone:813-505-7150
Mailing Address - Fax:
Practice Address - Street 1:2409 WOODY TRACE LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7122
Practice Address - Country:US
Practice Address - Phone:813-505-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
FL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL675941601Medicaid
FL675941696Medicaid