Healthcare Provider Details

I. General information

NPI: 1649533977
Provider Name (Legal Business Name): AIMEE F JENNINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W CALL ST
STARKE FL
32091-3210
US

IV. Provider business mailing address

2162 NE 154TH ST
STARKE FL
32091-6418
US

V. Phone/Fax

Practice location:
  • Phone: 352-235-1452
  • Fax: 904-964-5360
Mailing address:
  • Phone: 352-235-1452
  • Fax: 904-964-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AIMEE JENNINGS
Title or Position: OWNER
Credential:
Phone: 352-235-1452