Provider Demographics
NPI:1982175030
Name:KALIN, ASHLEY ANN (APRN-BC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:KALIN
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 IMPERATA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6093
Mailing Address - Country:US
Mailing Address - Phone:321-505-3999
Mailing Address - Fax:
Practice Address - Street 1:3628 IMPERATA DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6093
Practice Address - Country:US
Practice Address - Phone:321-505-3999
Practice Address - Fax:386-492-2949
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA182OtherMEDICARE HF