Individual
ASHLEY JENNIFER CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4129 N ARMENIA AVE, TAMPA, FL 33607-6436
(813) 879-3699
(813) 873-8469
Mailing address
4129 N ARMENIA AVE, TAMPA, FL 33607-6436
(813) 879-3699
(813) 873-8469
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN11003143
FL
363LP2300X
Primary Care Nurse Practitioner
11003143
FL
Other
Enumeration date
08/02/2019
Last updated
07/30/2021
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