Healthcare Provider Details

I. General information

NPI: 1073286449
Provider Name (Legal Business Name): ASHLEY NICOLE WALTERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8132 LEE VISTA BLVD STE B
ORLANDO FL
32829-8439
US

IV. Provider business mailing address

8132 LEE VISTA BLVD STE B
ORLANDO FL
32829-8439
US

V. Phone/Fax

Practice location:
  • Phone: 407-807-6522
  • Fax:
Mailing address:
  • Phone: 407-807-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11014525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: