Provider Demographics
NPI:1508142753
Name:LOEWEN, ASHLEE R (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:R
Last Name:LOEWEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3162
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-3162
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:841 PRUDENTIAL DR STE 180
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8350
Practice Address - Country:US
Practice Address - Phone:904-202-4600
Practice Address - Fax:904-202-4639
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX751454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286776401Medicaid
TX286776403Medicaid
TX8567NFOtherBCBS
TX286776402Medicaid
TX286776404Medicaid
TX8567NFOtherBCBS
TX286776401Medicaid
TXTXB141906Medicare PIN
TXTXB141908Medicare PIN