Provider Demographics
NPI:1346933892
Name:CUSSON, ASHLEY T (ARNP FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:T
Last Name:CUSSON
Suffix:
Gender:F
Credentials:ARNP FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3718
Mailing Address - Country:US
Mailing Address - Phone:985-500-5812
Mailing Address - Fax:
Practice Address - Street 1:990 AIRPOR ROAD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:850-269-6400
Practice Address - Fax:850-654-9581
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026661363LA2200X
FL11026661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118407900Medicaid