Healthcare Provider Details

I. General information

NPI: 1619880242
Provider Name (Legal Business Name): ASHTON BENTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4896 HIGHWAY 90 STE A
MARIANNA FL
32446-7840
US

IV. Provider business mailing address

4250 HOSPITAL DR
MARIANNA FL
32446-1917
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-6700
  • Fax: 850-526-6701
Mailing address:
  • Phone: 850-526-6700
  • Fax: 850-526-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: