Provider Demographics
NPI:1598181224
Name:LADSON, AISHA M (ARNP)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:M
Last Name:LADSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S LAWRENCE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-9222
Mailing Address - Country:US
Mailing Address - Phone:352-562-7927
Mailing Address - Fax:770-319-1019
Practice Address - Street 1:445 S LAWRENCE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9222
Practice Address - Country:US
Practice Address - Phone:352-562-7927
Practice Address - Fax:770-319-1019
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010827600Medicaid
FLHT490YMedicare PIN