Provider Demographics
NPI:1376143487
Name:JORGENSON STOUGH, AIMEE N (APRN CPNP-PC/AC)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:N
Last Name:JORGENSON STOUGH
Suffix:
Gender:F
Credentials:APRN CPNP-PC/AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 COCOA DR
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2046
Mailing Address - Country:US
Mailing Address - Phone:501-454-5143
Mailing Address - Fax:
Practice Address - Street 1:91550 OVERSEAS HWY STE 209
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2513
Practice Address - Country:US
Practice Address - Phone:305-853-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009518363LP0222X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care