Healthcare Provider Details

I. General information

NPI: 1285198671
Provider Name (Legal Business Name): AARON JOHN PLOTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 PARK AVE STE 205
ORANGE PARK FL
32073-5558
US

IV. Provider business mailing address

1242 GLYNLEA RD
JACKSONVILLE FL
32216-2612
US

V. Phone/Fax

Practice location:
  • Phone: 850-901-9281
  • Fax:
Mailing address:
  • Phone: 904-314-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22077
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: