Provider Demographics
NPI:1619504271
Name:FEDERICO, ASHTON (DO)
Entity Type:Individual
Prefix:DR
First Name:ASHTON
Middle Name:
Last Name:FEDERICO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2147
Mailing Address - Country:US
Mailing Address - Phone:904-563-5203
Mailing Address - Fax:
Practice Address - Street 1:1955 EUCLID ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2147
Practice Address - Country:US
Practice Address - Phone:904-563-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19308207P00000X
390200000X
GA94086207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program