Provider Demographics
NPI:1407253248
Name:GAGE, ASHLEIGH MARIE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:MARIE
Last Name:GAGE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 E VISTA GRANDE
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7162
Mailing Address - Country:US
Mailing Address - Phone:480-202-0508
Mailing Address - Fax:
Practice Address - Street 1:4135 S POWER RD STE 118
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212
Practice Address - Country:US
Practice Address - Phone:480-426-1566
Practice Address - Fax:480-275-3538
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN170753163W00000X
AZAP8832363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1154801785OtherGROUP NPI FOR ASHLEIGH GAGE NP, LLC