Healthcare Provider Details

I. General information

NPI: 1073556411
Provider Name (Legal Business Name): TERESA A. EDISON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA A. GREENQUIST

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT ROAD SUITE 4020
JACKSONVILLE FL
32216-1475
US

IV. Provider business mailing address

1824 KING STREET SUITE 300
JACKSONVILLE FL
32204-4736
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-6444
  • Fax: 904-296-9542
Mailing address:
  • Phone: 904-388-1820
  • Fax: 904-388-1827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30317
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1940972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: