Provider Demographics
NPI:1942768932
Name:MACCARELLO, ASHLEY (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MACCARELLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10308 W SAMPLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3942
Mailing Address - Country:US
Mailing Address - Phone:954-755-4880
Mailing Address - Fax:
Practice Address - Street 1:10308 W SAMPLE RD STE A
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3942
Practice Address - Country:US
Practice Address - Phone:954-755-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant