Provider Demographics
NPI:1174080238
Name:ARCHER VOSE, ASHLEY SUZANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SUZANNE
Last Name:ARCHER VOSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:SUZANNE
Other - Last Name:ARCHER-VOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7080 COTTONTAIL ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7035
Mailing Address - Country:US
Mailing Address - Phone:805-291-9216
Mailing Address - Fax:
Practice Address - Street 1:5725 RALSTON ST STE 101
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6053
Practice Address - Country:US
Practice Address - Phone:805-658-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner