MEDICARE: ASHLEY AGNEW APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11033989	FL

General Provider Information

NPI Number	:	1942048913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY AGNEW APRN

Provider Business Mailing Address
First Line	:	205 PALMA VISTA WAY APT 739
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-0941
Country	:	US
Telephone Number	:	937-546-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 SOUTHPARK BLVD STE 102
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-5122
Country	:	US
Telephone Number	:	904-342-5003
Fax Number	:	904-342-5550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	04/10/2025

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