Provider Demographics
NPI:1518571983
Name:SEGUNA, ASHLEY BROOKE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BROOKE
Last Name:SEGUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WOODLAND AVENUE
Mailing Address - Street 2:STE A
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2886
Mailing Address - Country:US
Mailing Address - Phone:321-613-2004
Mailing Address - Fax:321-613-2031
Practice Address - Street 1:30 WOODLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2886
Practice Address - Country:US
Practice Address - Phone:321-613-2004
Practice Address - Fax:321-613-2031
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015545363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program