Ashley Klaczak Mudra, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9106644 Issued in FL

Practice address

6224 NW 43Rd St Ste a
Gainesville, FL 32653-8874

Phone

(352) 332-6680

Fax

(352) 332-6604

NPI assigned

Sep 25, 2012

Last updated

Dec 16, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ashley A Klaczak Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544918400000",
    "number": "1275884769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6224 NW 43RD ST STE A",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326538874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6224 NW 43RD ST STE A",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326538874",
            "telephone_number": "352-332-6680",
            "fax_number": "352-332-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDRA",
        "first_name": "ASHLEY",
        "middle_name": "KLACZAK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-25",
        "last_updated": "2018-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006689200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ASHLEY",
            "last_name": "KLACZAK",
            "middle_name": "A",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Renee Moyer, OTR/L
• Khadijah Mozell
• David W Mozingo, MD
• Shanice Fontrell Mucher
• Jonathan S. Muchnick, MD
• Nicholas Andrew Mudra, PHYSICIAN ASSISTANT
• Stephen Mudra
• Marcus Muehlbauer, M.D.
• Brooke T Mueller, PHARMD
• Bruce A Mueller, OTR/L, CHT

• Physician Assistant in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.