1952807273 NPI number — DR. AIMEE NICOLE BETHANCOURT MD

Table of content: DR. AIMEE NICOLE BETHANCOURT MD (NPI 1952807273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952807273 NPI number — DR. AIMEE NICOLE BETHANCOURT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BETHANCOURT
Provider First Name:
AIMEE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952807273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 748817
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-8817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-286-0033
Provider Business Mailing Address Fax Number:
813-282-1806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 HOOKS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-241-6460
Provider Business Practice Location Address Fax Number:
352-241-6461
Provider Enumeration Date:
04/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: ME156596 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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