Provider Demographics
NPI:1346628732
Name:ASHTON, TINA M
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:ASHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 ROUTE 15 HWY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702
Mailing Address - Country:US
Mailing Address - Phone:570-772-4704
Mailing Address - Fax:
Practice Address - Street 1:1235 WEST SOUTHERN AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702
Practice Address - Country:US
Practice Address - Phone:570-772-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health