Provider Demographics
NPI:1053181735
Name:DANIEL, ASHLEY AZZURE (FNP -C)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:AZZURE
Last Name:DANIEL
Suffix:
Gender:
Credentials:FNP -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3854 SALIDA CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1000
Mailing Address - Country:US
Mailing Address - Phone:314-915-3089
Mailing Address - Fax:
Practice Address - Street 1:14021 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2763
Practice Address - Country:US
Practice Address - Phone:314-915-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024000240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily