Basic Information
Provider Information
NPI: 1831844182
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAYMAN
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7755 NATURE TRL
Address2:  
City: LAKELAND
State: FL
PostalCode: 338095076
CountryCode: US
TelephoneNumber: 8636513052
FaxNumber:  
Practice Location
Address1: 12902 USF MAGNOLIA DR
Address2:  
City: TAMPA
State: FL
PostalCode: 336129416
CountryCode: US
TelephoneNumber: 8886633488
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/15/2022
LastUpdateDate: 08/31/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/31/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA9114292FLY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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