Provider Demographics
NPI:1619436318
Name:MASSEY, ASHLEY J (APRN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:MASSEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CENTERVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4675
Mailing Address - Country:US
Mailing Address - Phone:850-877-5115
Mailing Address - Fax:850-656-3645
Practice Address - Street 1:1401 CENTERVILLE RD STE 300
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4675
Practice Address - Country:US
Practice Address - Phone:850-877-5115
Practice Address - Fax:506-563-6458
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014420363LF0000X
GARN220304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA060021232OtherDRIVER'S LICENSE