Provider Demographics
NPI:1992153324
Name:KOONCE, ASHLI SHAUNTEL
Entity type:Individual
Prefix:
First Name:ASHLI
Middle Name:SHAUNTEL
Last Name:KOONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 WELCH ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32310-5159
Mailing Address - Country:US
Mailing Address - Phone:850-575-6035
Mailing Address - Fax:
Practice Address - Street 1:1925 WELCH ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-5159
Practice Address - Country:US
Practice Address - Phone:850-570-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172A00000X, 172V00000X, 2279H0200X, 246W00000X, 251E00000X, 253Z00000X, 310400000X, 347C00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No347C00000XTransportation ServicesPrivate Vehicle
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program