Basic Information
| Provider Information | |||||||||
| NPI: | 1710072400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ASHCRAFT | ||||||||
| FirstName: | JEROLYN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 706 WHIPPOORWILL LN | ||||||||
| Address2: | |||||||||
| City: | DESTIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325411940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053101241 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4485 FURLING LN | ||||||||
| Address2: | |||||||||
| City: | DESTIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325415331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506541194 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | RN9225296 | FL | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.