Provider Demographics
NPI:1942048913
Name:AGNEW, ASHLEY (APRN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:AGNEW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 PALMA VISTA WAY APT 739
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-0941
Mailing Address - Country:US
Mailing Address - Phone:937-546-5656
Mailing Address - Fax:
Practice Address - Street 1:150 SOUTHPARK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5122
Practice Address - Country:US
Practice Address - Phone:904-342-5003
Practice Address - Fax:904-342-5550
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11033989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily