Healthcare Provider Details

I. General information

NPI: 1851003131
Provider Name (Legal Business Name): ASHLEY LYNN FAVA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 PROFESSIONAL VIEW DR BLDG 3002
FREEHOLD NJ
07728-7904
US

IV. Provider business mailing address

724 FAIRVIEW LN
FORKED RIVER NJ
08731-4965
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-1616
  • Fax:
Mailing address:
  • Phone: 609-661-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01412900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: