MEDICARE: MISS ASHLEY ANDREA NAZON LCSW

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	101YM0800X	Mental Health

General Provider Information

NPI Number	:	1609335884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ASHLEY ANDREA NAZON LCSW

Provider Business Mailing Address
First Line	:	8206 SOLANO BAY LOOP APT 422
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-9559
Country	:	US
Telephone Number	:	773-203-7263
Fax Number	:

Provider Business Practice Location Address
First Line	:	2604 CYPRESS RIDGE BLVD STE 102
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6311
Country	:	US
Telephone Number	:	813-517-6089
Fax Number	:

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

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	03/18/2019

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