Basic Information
| Provider Information | |||||||||
| NPI: | 1518571983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEGUNA | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 WOODLAND AVENUE | ||||||||
| Address2: | STE A | ||||||||
| City: | COCOA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329312886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216132004 | ||||||||
| FaxNumber: | 3216132031 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 WOODLAND AVE STE A | ||||||||
| Address2: | |||||||||
| City: | COCOA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329312886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216132004 | ||||||||
| FaxNumber: | 3216132031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2020 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 11015545 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.