Healthcare Provider Details

I. General information

NPI: 1790310167
Provider Name (Legal Business Name): ASHLEY PERENICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6536 GUNN HWY
TAMPA FL
33625-4022
US

IV. Provider business mailing address

7702 STILL PARK CIR
ODESSA FL
33556-2263
US

V. Phone/Fax

Practice location:
  • Phone: 813-803-0029
  • Fax: 813-949-8919
Mailing address:
  • Phone: 727-637-8520
  • Fax: 813-949-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberPA9116061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: