Provider Demographics
NPI:1396230504
Name:DAVIS, ASHLEY ELLIS (FNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELLIS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 CR 607E
Mailing Address - Street 2:
Mailing Address - City:BUSHNELL
Mailing Address - State:FL
Mailing Address - Zip Code:33513-3558
Mailing Address - Country:US
Mailing Address - Phone:352-457-3932
Mailing Address - Fax:
Practice Address - Street 1:17823 SE 109TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491
Practice Address - Country:US
Practice Address - Phone:352-693-2340
Practice Address - Fax:352-693-2345
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9344296363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner