Provider Demographics
NPI:1992228928
Name:SABBATINI, ASHLEY (AGACNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SABBATINI
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:REBECCA
Other - Last Name:GROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:012-592-7416
Practice Address - Fax:601-984-6439
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175125363LA2100X
MS902628363LA2100X
CT9408363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992228928Medicaid