Healthcare Provider Details

I. General information

NPI: 1598768145
Provider Name (Legal Business Name): TANIA C EDWARDS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22385 FLORA PARKE XING
FERNANDINA BEACH FL
32034-8000
US

IV. Provider business mailing address

22385 FLORA PARKE XING
FERNANDINA BEACH FL
32034-8000
US

V. Phone/Fax

Practice location:
  • Phone: 904-404-8641
  • Fax: 904-227-3246
Mailing address:
  • Phone: 904-404-8641
  • Fax: 904-227-3246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.917
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number053465
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS22812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: