Healthcare Provider Details

I. General information

NPI: 1083467724
Provider Name (Legal Business Name): AARON KEITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/13/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CUMBERLAND PARK DR STE 100
ST AUGUSTINE FL
32095-8955
US

IV. Provider business mailing address

1341 N LAURA ST
JACKSONVILLE FL
32206-4915
US

V. Phone/Fax

Practice location:
  • Phone: 904-201-9129
  • Fax:
Mailing address:
  • Phone: 904-465-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: