Provider Demographics
NPI:1609123108
Name:LIGHT, AIMEE ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:ELIZABETH
Last Name:LIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11827
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-1827
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:415 BROAD STREET
Practice Address - Street 2:STE 410
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4264
Practice Address - Country:US
Practice Address - Phone:423-239-9737
Practice Address - Fax:423-398-5500
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN17009363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner