Provider Demographics
NPI:1699052118
Name:WICKS, ASHLEY MORRIS (PA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MORRIS
Last Name:WICKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2191 9TH AVE N
Mailing Address - Street 2:STE 235
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7152
Mailing Address - Country:US
Mailing Address - Phone:813-977-0733
Mailing Address - Fax:813-971-2230
Practice Address - Street 1:2191 9TH AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7146
Practice Address - Country:US
Practice Address - Phone:727-327-0990
Practice Address - Fax:727-327-0895
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9106183OtherSTATE LICENSE