Healthcare Provider Details

I. General information

NPI: 1639306939
Provider Name (Legal Business Name): EDELINE DARDIGNAC ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 05/26/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 EAGLE LAKE DR
CLERMONT FL
34711
US

IV. Provider business mailing address

2642 EAGLE LAKE DR
CLERMONT FL
34711-6325
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-8612
  • Fax:
Mailing address:
  • Phone: 352-234-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9163120
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN9163120
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN9163120
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberARNP9163120
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberARNP9163120
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9163120
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP 9163120
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN9163120
License Number StateFL
# 9
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9163120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: