Provider Demographics
NPI:1033675467
Name:MCDANIEL, ASHLY (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLY
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 37TH ST N STE C
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6010
Mailing Address - Country:US
Mailing Address - Phone:727-328-1001
Mailing Address - Fax:727-327-0413
Practice Address - Street 1:3527 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6418
Practice Address - Country:US
Practice Address - Phone:229-247-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9141363A00000X
FLPA9115651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant