Provider Demographics
NPI:1497343529
Name:KENT, AARON (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:KENT
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11474 SW VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2391
Mailing Address - Country:US
Mailing Address - Phone:888-540-9660
Mailing Address - Fax:305-937-1733
Practice Address - Street 1:11474 SW VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-7321
Practice Address - Country:US
Practice Address - Phone:888-540-9660
Practice Address - Fax:305-937-1733
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty