Provider Demographics
NPI:1841428182
Name:PENN, ASHLEY B (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:B
Last Name:PENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVY MEDICINE SUPPORT COMMAND BLDG H 2005 KNIGHT LANE
Mailing Address - Street 2:ATTN: MEDICAL STAFF SERVICES
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212-0140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVY MEDICINE SUPPORT COMMAND BLDG H 2005 KNIGHT LANE
Practice Address - Street 2:ATTN: MEDICAL STAFF SERVICES
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:415-513-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program