Healthcare Provider Details

I. General information

NPI: 1811904790
Provider Name (Legal Business Name): CRISTINA L ASHWORTH CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE BLVD
INDIANAPOLIS IN
46202-1239
US

IV. Provider business mailing address

545 BARNHILL DR EH 215
INDIANAPOLIS IN
46202-5112
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-3256
  • Fax: 317-174-2940
Mailing address:
  • Phone: 317-948-0944
  • Fax: 317-274-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number7100132
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001132
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001132A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: