Individual
MISS AIMEE LYNN PROVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
11820 BEACH BLVD, JACKSONVILLE, FL 32246-6670
(904) 642-9100
Mailing address
4263 LOSCO RD APT 1122, JACKSONVILLE, FL 32257-1452
(904) 642-9100
(904) 641-6529
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
07/13/2012
Last updated
07/13/2012
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