Healthcare Provider Details

I. General information

NPI: 1750905691
Provider Name (Legal Business Name): ASHLEY ANNE FELLOWS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 GATEWAY BLVD STE 120
SOUTH SAN FRANCISCO CA
94080-7066
US

IV. Provider business mailing address

3409 HOLLYHOCK WAY
TAMPA FL
33618-2154
US

V. Phone/Fax

Practice location:
  • Phone: 650-761-4056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11013848
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: