Provider Demographics
NPI:1265959316
Name:GROSS, ASHLEY (FNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PRINCETON RD
Mailing Address - Street 2:STE B
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2049
Mailing Address - Country:US
Mailing Address - Phone:423-461-0021
Mailing Address - Fax:
Practice Address - Street 1:411 PRINCETON RD STE 101
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2049
Practice Address - Country:US
Practice Address - Phone:423-461-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000022920363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty