Healthcare Provider Details

I. General information

NPI: 1861264764
Provider Name (Legal Business Name): ASHLEY LATOSHA CRATIC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BISCAYNE BLVD
MIAMI FL
33132-1449
US

IV. Provider business mailing address

485 HIGHWAY 29 N
ATHENS GA
30601-5583
US

V. Phone/Fax

Practice location:
  • Phone: 877-870-0323
  • Fax: 866-427-3798
Mailing address:
  • Phone: 706-438-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN226771
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: