Healthcare Provider Details

I. General information

NPI: 1710833934
Provider Name (Legal Business Name): AARON DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 CHERRY ELM DR
SAINT AUGUSTINE FL
32092-0135
US

IV. Provider business mailing address

640 CHERRY ELM DR
SAINT AUGUSTINE FL
32092-0135
US

V. Phone/Fax

Practice location:
  • Phone: 808-554-1748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9547037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: