Aimee Lynn Provo, BS

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

11820 Beach Blvd
Jacksonville, FL 32246-6670

Phone

(904) 642-9100

NPI assigned

Jul 13, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health Resource Center Inc

  • Community Health Clinic/Center
  • Jacksonville, FL
  • NPI 1851407365
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342137600000",
    "number": "1194070367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4263 LOSCO RD APT 1122",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322571452",
            "telephone_number": "904-642-9100",
            "fax_number": "904-641-6529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11820 BEACH BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322466670",
            "telephone_number": "904-642-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVO",
        "first_name": "AIMEE",
        "middle_name": "LYNN",
        "name_prefix": "Miss",
        "credential": "BS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-13",
        "last_updated": "2012-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean T. Proulx
• Provenzano Counseling Services
• Liza Cristin Provenzano, LMHC
• Paul David Provenzano, DPT
• Providential Health Care, Inc
• Georgette Louise Provost-Dukes, NURSE PRACTITIONER
• Jacob Prows
• Charles Howell Pruden IV, MD
• Kathryn Pruden, MD
• Ma. Concepcion Mendoza Prudencio, MD

• Social Worker in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.