Healthcare Provider Details

I. General information

NPI: 1750776597
Provider Name (Legal Business Name): ASHLEY PARKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 7TH AVE N
ST PETERSBURG FL
33705-1300
US

IV. Provider business mailing address

1200 7TH AVE N
ST PETERSBURG FL
33705-1300
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-7737
  • Fax: 727-825-1223
Mailing address:
  • Phone: 727-820-7737
  • Fax: 727-825-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME129574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: