Healthcare Provider Details

I. General information

NPI: 1982989802
Provider Name (Legal Business Name): ASHLEY ANDREWS MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 ENTERPRISE RD. STE 103A
ORANGE CITY FL
32763
US

IV. Provider business mailing address

2845 ENTERPRISE RD. STE 103A
ORANGE CITY FL
32763
US

V. Phone/Fax

Practice location:
  • Phone: 386-347-0599
  • Fax:
Mailing address:
  • Phone: 386-347-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA64453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: