Healthcare Provider Details

I. General information

NPI: 1578375739
Provider Name (Legal Business Name): ASHTON D GREENE ARNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 E BRANDON BLVD
BRANDON FL
33511-5509
US

IV. Provider business mailing address

823 BENTLEY DR
FAIRBURN GA
30213-2150
US

V. Phone/Fax

Practice location:
  • Phone: 813-777-2021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11037040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: