Healthcare Provider Details

I. General information

NPI: 1689487704
Provider Name (Legal Business Name): ASHLEIGH GREENE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 RIVERVIEW ST
JACKSONVILLE FL
32208-2657
US

IV. Provider business mailing address

2724 TYLER CT
ORANGE PARK FL
32065-7676
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-5437
  • Fax:
Mailing address:
  • Phone: 619-361-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: