Provider Demographics
NPI:1326633942
Name:BURROW, ASHLIE JORDYN (FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLIE
Middle Name:JORDYN
Last Name:BURROW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 WINDING ROSE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3615 BROWNS BRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-4134
Practice Address - Country:US
Practice Address - Phone:678-456-4273
Practice Address - Fax:678-302-9665
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA252336163W00000X
UT13107426-4405363LF0000X
GARN252336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB7795757OtherDEA