Provider Demographics
NPI:1902408685
Name:HEAD, ASHLEY NICHOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:HEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18599 LAKE SHORE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1074
Mailing Address - Country:US
Mailing Address - Phone:163-836-0672
Mailing Address - Fax:216-383-5309
Practice Address - Street 1:18599 LAKE SHORE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1074
Practice Address - Country:US
Practice Address - Phone:216-383-5303
Practice Address - Fax:216-383-5309
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006655RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical