Provider Demographics
NPI:1538149166
Name:SIMMONS, LEONARD WILLIAM (PA)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:WILLIAM
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5551 NAVAHO DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8759
Mailing Address - Country:US
Mailing Address - Phone:850-497-9931
Mailing Address - Fax:
Practice Address - Street 1:765 6TH ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32511-5119
Practice Address - Country:US
Practice Address - Phone:850-452-6326
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9103209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant