Provider Demographics
NPI:1093477804
Name:ASHKAPOV, JOVAN (CNP)
Entity Type:Individual
Prefix:
First Name:JOVAN
Middle Name:
Last Name:ASHKAPOV
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 UPPER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-6134
Mailing Address - Country:US
Mailing Address - Phone:917-756-4015
Mailing Address - Fax:
Practice Address - Street 1:1432 UPPER CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-6134
Practice Address - Country:US
Practice Address - Phone:917-756-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55221363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care