Provider Demographics
NPI:1184160418
Name:ODOL, ASHLEY (CNA MA)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:ODOL
Suffix:
Gender:F
Credentials:CNA MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 REFLECTION COVE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8936
Mailing Address - Country:US
Mailing Address - Phone:904-601-8578
Mailing Address - Fax:
Practice Address - Street 1:641 REFLECTION COVE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8936
Practice Address - Country:US
Practice Address - Phone:904-601-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL317712376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide