Provider Demographics
NPI:1760910095
Name:ROBERTSON, ASHLEA ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEA
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ASHLEA
Other - Middle Name:ANN
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:5231 JOHN TYLER HWY
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2553
Practice Address - Country:US
Practice Address - Phone:757-220-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024174878OtherLICENSED NURSE PRACTITIONER