Healthcare Provider Details

I. General information

NPI: 1366029126
Provider Name (Legal Business Name): ASHLEY BROOKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 TOWN PLAZA AVE STE 105A
PONTE VEDRA FL
32081-5179
US

IV. Provider business mailing address

PO BOX 100237
GAINESVILLE FL
32610-0237
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-3233
  • Fax: 904-456-0819
Mailing address:
  • Phone: 352-392-4541
  • Fax: 352-294-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME166913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: