Provider Demographics
NPI:1912969015
Name:ASHBY, WENDY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ELIZABETH
Last Name:ASHBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ELIZABETH
Other - Last Name:MAYFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3639 DARNALL PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3639 DARNALL PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4215
Practice Address - Country:US
Practice Address - Phone:904-568-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA101969363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291869200Medicaid
970026513OtherRAILROAD MEDICARE
970026513OtherRAILROAD MEDICARE
FLE7418Medicare ID - Type Unspecified
S19268Medicare UPIN
FL291869200Medicaid