MEDICARE: ASHLEY FENDER APRN

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	363L00000X	Nurse Practitioner	11022190	FL

General Provider Information

NPI Number	:	1437874120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY FENDER APRN

Provider Business Mailing Address
First Line	:	2105 S PARK AVE
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-4349
Country	:	US
Telephone Number	:	407-878-0181
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-9116
Country	:	US
Telephone Number	:	386-774-0401
Fax Number	:

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

Provider Enumeration Date	:	10/05/2022
Last Update Date	:	12/21/2023

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