Healthcare Provider Details

I. General information

NPI: 1851963342
Provider Name (Legal Business Name): ASHLEY MARIE HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19441 GOLF VISTA PLAZA, SUITES 230 & 310
LEESBURG VA
20176-8272
US

IV. Provider business mailing address

3301 CAPTAIN WENDELL PRUITT WAY
FORT WASHINGTON MD
20744-1546
US

V. Phone/Fax

Practice location:
  • Phone: 703-729-3420
  • Fax: 703-729-3422
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: