Provider Demographics
NPI:1497147961
Name:NELSON, ASHLEY BROOKE (HAS, BC-HIS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BROOKE
Last Name:NELSON
Suffix:
Gender:F
Credentials:HAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N COLLIER BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-2725
Mailing Address - Country:US
Mailing Address - Phone:239-642-3805
Mailing Address - Fax:239-642-3805
Practice Address - Street 1:950 N COLLIER BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2725
Practice Address - Country:US
Practice Address - Phone:239-642-3805
Practice Address - Fax:239-642-3805
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4205247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other