Provider Demographics
NPI:1588494470
Name:O'HARE, AIMEE (RD, LDN)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:O'HARE
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7062 CRISPIN COVE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-8463
Mailing Address - Country:US
Mailing Address - Phone:301-775-9760
Mailing Address - Fax:
Practice Address - Street 1:7062 CRISPIN COVE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-8463
Practice Address - Country:US
Practice Address - Phone:301-775-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty