Provider Demographics
NPI:1063795102
Name:BLAKE, ASHLEE MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:MARIE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ASHLIE
Other - Middle Name:MARIE
Other - Last Name:HARSANYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 3726
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3726
Mailing Address - Country:US
Mailing Address - Phone:706-863-9595
Mailing Address - Fax:706-868-8375
Practice Address - Street 1:2626 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4402
Practice Address - Country:US
Practice Address - Phone:706-863-9595
Practice Address - Fax:706-868-8375
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022088Medicaid
KY7100183500Medicaid
OH0067159Medicaid
WV2671360OtherBCBS
WV2671360OtherBCBS