Provider Demographics
NPI:1396149613
Name:WILSON, ASHLEY (ARNP-BC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E SAMPLE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-4444
Mailing Address - Country:US
Mailing Address - Phone:954-941-4530
Mailing Address - Fax:
Practice Address - Street 1:440 E SAMPLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-4444
Practice Address - Country:US
Practice Address - Phone:954-941-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9262469363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily