Provider Demographics
NPI:1295396661
Name:CROOM, ASHLEY TRUSSELL (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TRUSSELL
Last Name:CROOM
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:TRUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:601-298-4173
Mailing Address - Fax:877-866-2356
Practice Address - Street 1:1220 E NORTHSIDE DR STE 220
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5503
Practice Address - Country:US
Practice Address - Phone:601-298-4173
Practice Address - Fax:877-866-2356
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner