Healthcare Provider Details

I. General information

NPI: 1508142753
Provider Name (Legal Business Name): ASHLEE R LOEWEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR STE 180
JACKSONVILLE FL
32207-8350
US

IV. Provider business mailing address

PO BOX 3162
SALT LAKE CITY UT
84110-3162
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-4600
  • Fax: 904-202-4639
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number751454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: