Individual
ASHLEY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, RD, LD/N
Contact information
Practice address
1301 S INTERNATIONAL PKWY STE 1041, LAKE MARY, FL 32746-1410
(407) 732-7668
Mailing address
3675 SIMONTON PL, LAKE MARY, FL 32746-6752
(772) 834-7342
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
ND7124
FL
363A00000X
Physician Assistant
Primary
PA9113579
FL
Other
Enumeration date
09/29/2020
Last updated
04/07/2025
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