Provider Demographics
NPI:1649728999
Name:PEDERSEN, ASHZRA (DNP, RN, FNP-C, AGNP)
Entity type:Individual
Prefix:
First Name:ASHZRA
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:DNP, RN, FNP-C, AGNP
Other - Prefix:
Other - First Name:ASHZRA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, RN, FNP-C, AGNP
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4663 SCOTTS VALLEY DR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4202
Practice Address - Country:US
Practice Address - Phone:831-458-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAG08170091363LG0600X
CAF07170649363LF0000X
CA95007248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology