Provider Demographics
NPI:1003902446
Name:ASH, JILL VIRGINIA (PA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:VIRGINIA
Last Name:ASH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:VIRGINIA
Other - Last Name:SOHASKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-1568
Mailing Address - Country:US
Mailing Address - Phone:850-769-6612
Mailing Address - Fax:850-769-3533
Practice Address - Street 1:339 RACETRACK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-7900
Practice Address - Fax:850-864-3094
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101487363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant