Provider Demographics
NPI:1851021984
Name:JACKSON, ASHLEY KATHLEEN (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KATHLEEN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6771 PROFESSIONAL PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8482
Mailing Address - Country:US
Mailing Address - Phone:941-907-7372
Mailing Address - Fax:941-373-6650
Practice Address - Street 1:6771 PROFESSIONAL PKWY STE 203
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8482
Practice Address - Country:US
Practice Address - Phone:941-907-7372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020148207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology