Healthcare Provider Details

I. General information

NPI: 1932936184
Provider Name (Legal Business Name): ASHLI OLIVIA GORDON-THOMAS RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD FL 1
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100214, 1329 SW 16TH STREET SUITE 5251
GAINESVILLE FL
32610-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9400
  • Fax:
Mailing address:
  • Phone: 352-273-9472
  • Fax: 352-627-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND13419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: