Healthcare Provider Details

I. General information

NPI: 1962075796
Provider Name (Legal Business Name): ASHLEY MARIE ETHINGTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 WHIPPOORWILL LN
NAPLES FL
34105-3847
US

IV. Provider business mailing address

1095 WHIPPOORWILL LN
NAPLES FL
34105-3847
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-4404
  • Fax:
Mailing address:
  • Phone: 239-261-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11015215
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11015215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: