MEDICARE: DR. ASHLEY JESSICA FALK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	23082	NE
2	207Q00000X	Family Medicine Physician	ME124584	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386671063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY JESSICA FALK M.D.

Provider Business Mailing Address
First Line	:	1201 1ST ST S STE 100A
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3904
Country	:	US
Telephone Number	:	863-280-6080
Fax Number	:	863-229-7587

Provider Business Practice Location Address
First Line	:	1201 1ST ST S STE 100A
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3904
Country	:	US
Telephone Number	:	863-280-6080
Fax Number	:	863-229-7587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	03/30/2022

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