Provider Demographics
NPI:1013457407
Name:UPHAM, ASHLEY (AP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:UPHAM
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14804 NW 140TH ST
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-6276
Mailing Address - Country:US
Mailing Address - Phone:386-462-0020
Mailing Address - Fax:
Practice Address - Street 1:14804 NW 140TH ST
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-6276
Practice Address - Country:US
Practice Address - Phone:386-462-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3701171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist