Healthcare Provider Details

I. General information

NPI: 1124984471
Provider Name (Legal Business Name): ASHLEY DIANE CURTIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S RIVERSIDE PL
INDIALANTIC FL
32903-4259
US

IV. Provider business mailing address

748 PEREGRINE DR
INDIALANTIC FL
32903-4775
US

V. Phone/Fax

Practice location:
  • Phone: 321-378-1207
  • Fax:
Mailing address:
  • Phone: 352-441-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11044485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: