Provider Demographics
NPI:1740414044
Name:AYNES, DARRICK TODD (HIS)
Entity Type:Individual
Prefix:MR
First Name:DARRICK
Middle Name:TODD
Last Name:AYNES
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 CENTRALIA CT
Mailing Address - Street 2:SUITE #104
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3700
Mailing Address - Country:US
Mailing Address - Phone:352-360-0554
Mailing Address - Fax:352-360-1799
Practice Address - Street 1:8112 CENTRALIA CT
Practice Address - Street 2:SUITE #104
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3700
Practice Address - Country:US
Practice Address - Phone:352-360-0554
Practice Address - Fax:352-360-1799
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS 4310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT0937OtherBCBS - PROVIDER #