Provider Demographics
NPI:1093148736
Name:BAUM, ASHLEY ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:BAUM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ANN
Other - Last Name:CORNWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1545 9TH ST. S.W.
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962
Mailing Address - Country:US
Mailing Address - Phone:772-257-8224
Mailing Address - Fax:772-571-8846
Practice Address - Street 1:1545 9TH ST. S.W.
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962
Practice Address - Country:US
Practice Address - Phone:772-257-8224
Practice Address - Fax:772-571-8846
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9254706363LF0000X
FL9254706363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010329300Medicaid