Basic Information
| Provider Information | |||||||||
| NPI: | 1811505332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMERSTROM | ||||||||
| FirstName: | ASHLYN | ||||||||
| MiddleName: | SEWARD | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SEWARD | ||||||||
| OtherFirstName: | ASHLYN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13515 FOREST LAKE DR | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337715002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077600776 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5030 78TH AVE N STE 11 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337812406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275451273 | ||||||||
| FaxNumber: | 8007138330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2020 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT20116793 | FL | Y |
No ID Information.