Provider Demographics
NPI:1902522030
Name:BOERJAN, ASHLEY ANNA (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANNA
Last Name:BOERJAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ANNA
Other - Last Name:QUINTANILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2510 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4188
Mailing Address - Country:US
Mailing Address - Phone:361-664-4445
Mailing Address - Fax:616-644-4493
Practice Address - Street 1:2510 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4188
Practice Address - Country:US
Practice Address - Phone:361-664-4445
Practice Address - Fax:361-664-4449
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty