Healthcare Provider Details

I. General information

NPI: 1437980034
Provider Name (Legal Business Name): ASHLEIGH GASS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 CLEVELAND ST APT 1212
CLEARWATER FL
33755-6619
US

IV. Provider business mailing address

628 CLEVELAND ST APT 1212
CLEARWATER FL
33755-6619
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-0065
  • Fax:
Mailing address:
  • Phone: 310-666-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number16359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: