Provider Demographics
NPI:1639770340
Name:FLECK, ASHLEY MAE (FNP-BC, PMHNP- BC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MAE
Last Name:FLECK
Suffix:
Gender:
Credentials:FNP-BC, PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120161
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32912-0161
Mailing Address - Country:US
Mailing Address - Phone:321-425-2424
Mailing Address - Fax:321-256-5000
Practice Address - Street 1:3040 N WICKHAM RD STE 3
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2369
Practice Address - Country:US
Practice Address - Phone:321-425-2424
Practice Address - Fax:321-256-5000
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007648363LP0808X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily