Provider Demographics
NPI:1063094514
Name:CONCEPCION, ASHLEY MEGAN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MEGAN
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5751
Mailing Address - Country:US
Mailing Address - Phone:910-545-3666
Mailing Address - Fax:
Practice Address - Street 1:1290 WATERMAN WAY STE 1290
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5229
Practice Address - Country:US
Practice Address - Phone:352-742-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily