Provider Demographics
NPI:1841936952
Name:CHARLES, AIMEE (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:BOUDREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10184 BENGAL FOX DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-4146
Mailing Address - Country:US
Mailing Address - Phone:386-972-7078
Mailing Address - Fax:
Practice Address - Street 1:1409 KINGSLEY AVE STE 8
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4553
Practice Address - Country:US
Practice Address - Phone:907-269-7200
Practice Address - Fax:904-269-0700
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9463320163W00000X
FL2022027840363LP0808X
FL11020701363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse