Healthcare Provider Details

I. General information

NPI: 1154994903
Provider Name (Legal Business Name): ASHLYN DRAKE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SHIRLINGTON RD STE 102
ARLINGTON VA
22206-3603
US

IV. Provider business mailing address

11350 MCCORMICK ROAD EXECUTIVE PLAZA 1, STE 501
HUNT VALLEY MD
21031
US

V. Phone/Fax

Practice location:
  • Phone: 703-738-4336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: