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General NPI Number Information
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NPI Number | 1396230504
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Entity Type | Individual
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Provider Name | ASHLEY ELLIS DAVIS FNP
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Gender | Female
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 17823 SE 109TH AVE SUITE 108
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City | SUMMERFIELD
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State | FL
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Zip | 34491
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Country | US
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Telephone | 352-693-2340
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Fax | 352-693-2345
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Provider Business Mailing Address
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Address Line | 1640 CR 607E
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City | BUSHNELL
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State | FL
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Zip | 33513-3558
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Country | US
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Telephone | 352-457-3932
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 9344296
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License Number State | FL
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