Provider Demographics
NPI:1679158216
Name:MCGUFFIN, ASHLEY (APRN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MCGUFFIN
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:209 E PAT RADY WAY
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:IN
Practice Address - Zip Code:46105-5508
Practice Address - Country:US
Practice Address - Phone:765-301-7679
Practice Address - Fax:765-301-7677
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-174104363LF0000X
FLAPRN11014026363LF0000X
IN71014854A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1660-64-8389Other0000000