Healthcare Provider Details

I. General information

NPI: 1972414753
Provider Name (Legal Business Name): ASHLEY BAGGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 BARDIN RD
PALATKA FL
32177-8799
US

IV. Provider business mailing address

1511 BARDIN RD
PALATKA FL
32177-8799
US

V. Phone/Fax

Practice location:
  • Phone: 904-466-2755
  • Fax: 386-328-3972
Mailing address:
  • Phone: 904-466-2755
  • Fax: 386-328-3972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDA9922
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: