Healthcare Provider Details

I. General information

NPI: 1538625876
Provider Name (Legal Business Name): ASHLEIGH HOTALING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 HIGHWAY 9 E STE 100A
LITTLE RIVER SC
29566-8163
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-390-8320
  • Fax: 843-390-8329
Mailing address:
  • Phone: 843-390-8320
  • Fax: 843-390-8329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22621
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: