Basic Information
| Provider Information | |||||||||
| NPI: | 1104440676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHLOCK | ||||||||
| FirstName: | CALLIE | ||||||||
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| Credential: | CNM, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6069 18TH ST S | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337124909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6187311746 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1344 22ND ST S | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337122744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278248181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2020 | ||||||||
| LastUpdateDate: | 08/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | APRN11007273 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363L00000X | 11007273 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.