Provider Demographics
NPI:1811904790
Name:ASHWORTH, CRISTINA L (CFNP)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:L
Last Name:ASHWORTH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:545 BARNHILL DR EH 215
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:317-948-0944
Mailing Address - Fax:317-274-2940
Practice Address - Street 1:1701 N SENATE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-3256
Practice Address - Fax:317-174-2940
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN7100132204F00000X
IN71001132363L00000X
IN71001132A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200398360Medicaid
IN200398360Medicaid