Healthcare Provider Details

I. General information

NPI: 1184435547
Provider Name (Legal Business Name): ASHLEY GLENN DUTTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3953 TAMPA RD # 101
OLDSMAR FL
34677-3233
US

IV. Provider business mailing address

3953 TAMPA RD STE 101
OLDSMAR FL
34677-3233
US

V. Phone/Fax

Practice location:
  • Phone: 727-464-2867
  • Fax:
Mailing address:
  • Phone: 727-464-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: