Provider Demographics
NPI:1134720964
Name:AMBROISE, ARLIOMEY
Entity type:Individual
Prefix:
First Name:ARLIOMEY
Middle Name:
Last Name:AMBROISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2178
Mailing Address - Country:US
Mailing Address - Phone:754-234-7470
Mailing Address - Fax:
Practice Address - Street 1:2216 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2178
Practice Address - Country:US
Practice Address - Phone:754-234-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily