Healthcare Provider Details

I. General information

NPI: 1609973890
Provider Name (Legal Business Name): EDITH CAROL ERICKSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E DUVAL ST
JACKSONVILLE FL
32202-3201
US

IV. Provider business mailing address

213 EDGE OF WOODS RD
ST AUGUSTINE FL
32092-0784
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-2766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9383351
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9383351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: