Healthcare Provider Details

I. General information

NPI: 1710445176
Provider Name (Legal Business Name): ASHLEY LYNN ELLINGTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY LYNN DRURY

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD UNIT 10-2
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD UNIT 10-2
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 523-265-6102
  • Fax:
Mailing address:
  • Phone: 523-265-6102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9384641
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11014286
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: