Provider Demographics
NPI:1750605440
Name:HALL, AIMEE SUZANNE (ARNP)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:SUZANNE
Last Name:HALL
Suffix:
Gender:F
Credentials:ARNP
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 3725
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3725
Mailing Address - Country:US
Mailing Address - Phone:706-863-9595
Mailing Address - Fax:
Practice Address - Street 1:2010 59TH ST W STE 2200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4689
Practice Address - Country:US
Practice Address - Phone:941-794-5621
Practice Address - Fax:941-761-1532
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9186993363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9186993OtherMEDICAL LICENSE
DS795ZMedicare PIN