Healthcare Provider Details

I. General information

NPI: 1912396177
Provider Name (Legal Business Name): ASHLEY NICOLE PEBBLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE SANTILLO AGPC-NP

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 09/23/2026
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 N . MAIN ST.
PITTSFORD NY
14534
US

IV. Provider business mailing address

355 HAMMOCKS DR
FAIRPORT NY
14450-7006
US

V. Phone/Fax

Practice location:
  • Phone: 585-520-2530
  • Fax: 585-301-4003
Mailing address:
  • Phone: 585-520-2530
  • Fax: 585-301-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309179
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number664269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: