Provider Demographics
NPI:1477672228
Name:BAHL, ASHIMA (ARNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ASHIMA
Middle Name:
Last Name:BAHL
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:MRS
Other - First Name:ASHIMA
Other - Middle Name:
Other - Last Name:BAHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP-BC
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13330 USF LAUREL DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6601
Practice Address - Country:US
Practice Address - Phone:813-396-9478
Practice Address - Fax:813-905-9838
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9171318363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY05CEOtherBLUE CROSS BLUE SHIELD
FL000476600Medicaid
BA296ZMedicare PIN
FL000476600Medicaid