Provider Demographics
NPI:1487870077
Name:ANDERSON, ASHLEY LAINE (FNP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LAINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 PARK AVE S STE 16389
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1502
Mailing Address - Country:US
Mailing Address - Phone:646-876-8455
Mailing Address - Fax:833-314-0246
Practice Address - Street 1:228 PARK AVE S
Practice Address - Street 2:STE 16389
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1502
Practice Address - Country:US
Practice Address - Phone:646-876-8455
Practice Address - Fax:833-314-0246
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN149538363L00000X
TN0000012721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner