Provider Demographics
NPI:1043109747
Name:MACISAAC, ASHLEY (APRN)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:MACISAAC
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 VIA CASTILLA
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6919
Mailing Address - Country:US
Mailing Address - Phone:774-262-3552
Mailing Address - Fax:
Practice Address - Street 1:1213 E LAS OLAS BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2331
Practice Address - Country:US
Practice Address - Phone:954-982-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11039669163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical