MEDICARE: AARON JOSHUA SIMMS LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AL5525	OTHER	FL	FLORIDA BOARD OF ATHLETIC TRAINING
2	BOC352371	OTHER		BOARD OF CERTIFICATION

General Provider Information

NPI Number	:	1699302018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON JOSHUA SIMMS LAT, ATC

Provider Business Mailing Address
First Line	:	8536 ALDERWOOD CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5952
Country	:	US
Telephone Number	:	904-349-5987
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 VILLAGE OAKS DR
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-3876
Country	:	US
Telephone Number	:	904-240-0442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	03/25/2020

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