Healthcare Provider Details

I. General information

NPI: 1306760525
Provider Name (Legal Business Name): AIMEE FONTAINE CRDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12106 US HIGHWAY 301 N
PARRISH FL
34219-8473
US

IV. Provider business mailing address

12106 US HIGHWAY 301 N
PARRISH FL
34219-8473
US

V. Phone/Fax

Practice location:
  • Phone: 941-212-2705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH20227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: