Healthcare Provider Details

I. General information

NPI: 1932473121
Provider Name (Legal Business Name): ASHLEY FOWLER P.A-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 05/25/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 SR 64 #
BRADENTON FL
34212
US

IV. Provider business mailing address

8000 SR 64 #
BRADENTON FL
34212
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-1404
  • Fax: 941-795-1717
Mailing address:
  • Phone: 941-792-1404
  • Fax: 941-795-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9106487
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: