MEDICARE: DR. ASHLEY J TANTON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	103TH0004X	Health Psychologist	PY11501	FL
3	103TR0400X	Rehabilitation Psychologist	PY11501	FL
4	103TC0700X	Clinical Psychologist	PY11501	FL
5	103TB0200X	Cognitive & Behavioral Psychologist	PY11501	FL
6	103G00000X	Clinical Neuropsychologist	PY11501	FL
7	103TF0200X	Forensic Psychologist	PY11501	FL

General Provider Information

NPI Number	:	1598191801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHLEY J TANTON PSY.D.

Provider Business Mailing Address
First Line	:	2100 SE HILLMOOR DR STE 201
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-8057
Country	:	US
Telephone Number	:	772-278-5508
Fax Number	:	772-673-6225

Provider Business Practice Location Address
First Line	:	2100 SE HILLMOOR DR STE 201
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-8057
Country	:	US
Telephone Number	:	772-278-5508
Fax Number	:	772-673-6225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	06/27/2026

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