Provider Demographics
NPI:1235460528
Name:KIRKLAND, ASHLEE FAYE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ASHLEE
Middle Name:FAYE
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:FAYE
Other - Last Name:EBERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4197 WOODLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3493
Mailing Address - Country:US
Mailing Address - Phone:813-333-1512
Mailing Address - Fax:813-333-1561
Practice Address - Street 1:1425 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3491
Practice Address - Country:US
Practice Address - Phone:813-253-2635
Practice Address - Fax:813-254-7142
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110247900Medicaid