Provider Demographics
NPI:1508243023
Name:THOMAS, ASHLEY (APRN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:WISENBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:921 N CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-3422
Mailing Address - Country:US
Mailing Address - Phone:352-436-4328
Mailing Address - Fax:352-260-0960
Practice Address - Street 1:7562 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7840
Practice Address - Country:US
Practice Address - Phone:352-436-4328
Practice Address - Fax:352-260-0960
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9308390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIH914ZMedicare PIN