Provider Demographics
NPI:1447085956
Name:SIMPSON, JOAN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:SIMPSON
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 1:2240 RIVERDALE DR N
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3824
Mailing Address - Country:US
Mailing Address - Phone:954-692-4236
Mailing Address - Fax:754-263-7134
Practice Address - Street 1:2240 RIVERDALE DR N
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3824
Practice Address - Country:US
Practice Address - Phone:954-692-4236
Practice Address - Fax:754-263-7134
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
FL13570310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123350800Medicaid