Provider Demographics
NPI:1609694066
Name:PIERRE, SIMON C
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:C
Last Name:PIERRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:N
Other - Last Name:PIERRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4602 DORA AVE S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33976-4789
Mailing Address - Country:US
Mailing Address - Phone:239-209-7019
Mailing Address - Fax:
Practice Address - Street 1:4601 DORA AVE S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33976-4744
Practice Address - Country:US
Practice Address - Phone:239-209-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care