Healthcare Provider Details

I. General information

NPI: 1497343529
Provider Name (Legal Business Name): AARON KENT PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11474 SW VILLAGE PKWY
PORT ST LUCIE FL
34987-7321
US

IV. Provider business mailing address

11474 SW VILLAGE PKWY
PORT ST. LUCIE FL
34987-2391
US

V. Phone/Fax

Practice location:
  • Phone: 888-540-9660
  • Fax: 305-937-1733
Mailing address:
  • Phone: 888-540-9660
  • Fax: 305-937-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: