Provider Demographics
NPI:1669156022
Name:SIMPKINS, ANTONIO JERMAINE
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:JERMAINE
Last Name:SIMPKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 S CYPRESS BEND DR APT 419
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4478
Mailing Address - Country:US
Mailing Address - Phone:954-557-3453
Mailing Address - Fax:
Practice Address - Street 1:2316 S CYPRESS BEND DR APT 419
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4478
Practice Address - Country:US
Practice Address - Phone:954-557-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-270766106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty