Provider Demographics
NPI:1407273196
Name:NIELSEN, ASHLY (CST)
Entity Type:Individual
Prefix:MS
First Name:ASHLY
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 SW 48TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-5645
Mailing Address - Country:US
Mailing Address - Phone:954-534-1118
Mailing Address - Fax:954-566-9066
Practice Address - Street 1:4326 SW 48TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33314-5645
Practice Address - Country:US
Practice Address - Phone:954-534-1118
Practice Address - Fax:954-566-9066
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL146749246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146749OtherNATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING