Healthcare Provider Details

I. General information

NPI: 1568832475
Provider Name (Legal Business Name): ASHLEY LYN HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY LYN BRADY FNP

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ENGLISH CREEK AVE STE 223
EGG HARBOR TWP NJ
08234-5598
US

IV. Provider business mailing address

1 N. WHITE HORSE PIKE
HAMMONTON NJ
08037
US

V. Phone/Fax

Practice location:
  • Phone: 609-407-2243
  • Fax: 609-593-9850
Mailing address:
  • Phone: 609-567-0434
  • Fax: 609-567-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00585900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: