Healthcare Provider Details

I. General information

NPI: 1982175030
Provider Name (Legal Business Name): ASHLEY ANN KALIN APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 IMPERATA DR
ROCKLEDGE FL
32955-6093
US

IV. Provider business mailing address

3628 IMPERATA DR
ROCKLEDGE FL
32955-6093
US

V. Phone/Fax

Practice location:
  • Phone: 321-505-3999
  • Fax: 386-492-2949
Mailing address:
  • Phone: 321-505-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: