Healthcare Provider Details

I. General information

NPI: 1124456462
Provider Name (Legal Business Name): ASHLEY ELIZABETH NIELSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

3500 N BROAD ST
PHILADELPHIA PA
19140-4106
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-2581
  • Fax: 215-214-4038
Mailing address:
  • Phone: 215-707-2433
  • Fax: 215-662-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056347
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: