Healthcare Provider Details

I. General information

NPI: 1699302018
Provider Name (Legal Business Name): AARON JOSHUA SIMMS LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 VILLAGE OAKS DR
ST JOHNS FL
32259-3876
US

IV. Provider business mailing address

8536 ALDERWOOD CT
JACKSONVILLE FL
32244-5952
US

V. Phone/Fax

Practice location:
  • Phone: 904-240-0442
  • Fax:
Mailing address:
  • Phone: 904-349-5987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: