Healthcare Provider Details

I. General information

NPI: 1750053039
Provider Name (Legal Business Name): ASHLEY PAGE TUTTLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 RIVERS AVE
NORTH CHARLESTON SC
29406-4882
US

IV. Provider business mailing address

9313 MEDICAL PLAZA DR STE 202
NORTH CHARLESTON SC
29406-9176
US

V. Phone/Fax

Practice location:
  • Phone: 843-818-5100
  • Fax: 843-569-5899
Mailing address:
  • Phone: 843-572-1200
  • Fax: 843-569-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number25443
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number25443
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25443
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: