Basic Information
| Provider Information | |||||||||
| NPI: | 1265188940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAY | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 PARK ST N STE 1017 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446569 | ||||||||
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| Practice Location | |||||||||
| Address1: | 425 S PARSONS AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446569 | ||||||||
| FaxNumber: | 7273844388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2022 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 656244 | FL | N | Nursing Service Providers | Registered Nurse | 363LF0000X | RN9332905 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | APRN11018472 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 11018472 | 01 | FL | STATE LICENSE | OTHER |