Provider Demographics
NPI:1326488180
Name:KIEVIT, ASHLEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:KIEVIT
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 1:4129 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6436
Mailing Address - Country:US
Mailing Address - Phone:813-879-3699
Mailing Address - Fax:813-873-8469
Practice Address - Street 1:4129 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6436
Practice Address - Country:US
Practice Address - Phone:813-879-3699
Practice Address - Fax:813-873-8469
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9107244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant