Healthcare Provider Details

I. General information

NPI: 1508463779
Provider Name (Legal Business Name): ASHLEY ZANDERS WALTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 SR-19 S
EUSTIS FL
32726
US

IV. Provider business mailing address

2121 W PENSACOLA ST STE B2
TALLAHASSEE FL
32304-3151
US

V. Phone/Fax

Practice location:
  • Phone: 352-492-1564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11009063
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11009063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: