Healthcare Provider Details

I. General information

NPI: 1609473461
Provider Name (Legal Business Name): ASHTON ELAN HINDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7778 SW JACK JAMES DR
STUART FL
34997-7249
US

IV. Provider business mailing address

1090 WOODBINE WAY
RIVIERA BEACH FL
33418-6559
US

V. Phone/Fax

Practice location:
  • Phone: 504-669-9099
  • Fax:
Mailing address:
  • Phone: 562-405-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: