Provider Demographics
NPI:1407129117
Name:SPENCER, ASHLEY A (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:A
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:A
Other - Last Name:FLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:86648 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6446
Mailing Address - Country:US
Mailing Address - Phone:904-563-4228
Mailing Address - Fax:
Practice Address - Street 1:4800 BELFORT RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6004
Practice Address - Country:US
Practice Address - Phone:904-483-5850
Practice Address - Fax:904-265-6409
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9262984367500000X
GAAPRN231039367500000X
FLAPRN9262984367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004614200Medicaid
FLG00X2OtherBLUE SHIELD
FL004614200Medicaid