Healthcare Provider Details

I. General information

NPI: 1033604129
Provider Name (Legal Business Name): ASHTON M RETY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHTON M JOHNSON DO

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9911 CORKSCREW RD STE 101
ESTERO FL
33928-3323
US

IV. Provider business mailing address

9911 CORKSCREW RD STE 101
ESTERO FL
33928-3323
US

V. Phone/Fax

Practice location:
  • Phone: 239-947-5000
  • Fax:
Mailing address:
  • Phone: 239-768-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS17905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: