Provider Demographics
NPI:1306294517
Name:CAIN, ASHLEY MICCICHE (PA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICCICHE
Last Name:CAIN
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Gender:F
Credentials:PA
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Mailing Address - Street 1:3901 COCONUT PALM DR STE 120
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8362
Mailing Address - Country:US
Mailing Address - Phone:954-377-3113
Mailing Address - Fax:865-560-7088
Practice Address - Street 1:3030 N ROCKY POINT DR W
Practice Address - Street 2:STE 670
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5803
Practice Address - Country:US
Practice Address - Phone:813-289-6597
Practice Address - Fax:813-289-6592
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2020-01-03
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Provider Licenses
StateLicense IDTaxonomies
FLPA9109482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant