Provider Demographics
NPI:1386671063
Name:FALK, ASHLEY JESSICA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:JESSICA
Last Name:FALK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 1ST ST S STE 100A
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3904
Mailing Address - Country:US
Mailing Address - Phone:863-280-6080
Mailing Address - Fax:863-229-7587
Practice Address - Street 1:1201 1ST ST S STE 100A
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3904
Practice Address - Country:US
Practice Address - Phone:863-280-6080
Practice Address - Fax:863-229-7587
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23082207Q00000X
FLME124584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017913200Medicaid