Provider Demographics
NPI:1235432261
Name:BRIGGS, ASHLEY GORTEMOLLER (ARNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GORTEMOLLER
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 8TH ST S
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4730
Mailing Address - Country:US
Mailing Address - Phone:727-329-8833
Mailing Address - Fax:727-329-8840
Practice Address - Street 1:600 8TH STREET SOUTH
Practice Address - Street 2:SUITE A
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-329-8830
Practice Address - Fax:727-329-8840
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3407702363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health