Provider Demographics
NPI:1306588611
Name:ANDERSON, ASHLEE RENEA (PMHNP)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:RENEA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 E MOWRY DR APT 104
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-8175
Mailing Address - Country:US
Mailing Address - Phone:786-234-0725
Mailing Address - Fax:
Practice Address - Street 1:1758 COUNTY SERVICES PKWY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4012
Practice Address - Country:US
Practice Address - Phone:404-301-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018599363LP0808X
GAGAA-NP001985363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health