Provider Demographics
NPI:1639496565
Name:VRECENAK, ASHLEY R (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:VRECENAK
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:515 W STATE ROAD 434
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4981
Mailing Address - Country:US
Mailing Address - Phone:407-332-8080
Mailing Address - Fax:407-260-0602
Practice Address - Street 1:515 W STATE ROAD 434
Practice Address - Street 2:SUITE 210
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4981
Practice Address - Country:US
Practice Address - Phone:407-332-8080
Practice Address - Fax:407-260-0602
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2016-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105430363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDK200UMedicare PIN
DK200XMedicare PIN