Provider Demographics
NPI:1780812586
Name:TIEU, AIMEE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:LYNN
Last Name:TIEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AIMEE
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9561
Mailing Address - Fax:321-434-9231
Practice Address - Street 1:8725 N WICKHAM RD
Practice Address - Street 2:SUITE 302
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2239
Practice Address - Country:US
Practice Address - Phone:321-434-9561
Practice Address - Fax:321-434-9231
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104414207VF0040X, 207VG0400X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic Surgery
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001261800Medicaid
FL001261800Medicaid