Provider Demographics
NPI:1609115161
Name:PANE, ASHLEY NICOLE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:PANE
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:KERAMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8926 77TH TER E UNIT 892677TH
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6417
Mailing Address - Country:US
Mailing Address - Phone:941-907-0222
Mailing Address - Fax:941-907-0493
Practice Address - Street 1:8926 77TH TER E UNIT 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-6417
Practice Address - Country:US
Practice Address - Phone:941-907-0222
Practice Address - Fax:941-907-0493
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118645363A00000X
PAMA060760363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant