Healthcare Provider Details

I. General information

NPI: 1538493036
Provider Name (Legal Business Name): KHADINE EDWARDS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4243 NW FEDERAL HWY
JENSEN BEACH FL
34957-3600
US

IV. Provider business mailing address

1942 SW MCALLISTER LN
PORT ST LUCIE FL
34953-2063
US

V. Phone/Fax

Practice location:
  • Phone: 800-735-1178
  • Fax:
Mailing address:
  • Phone: 212-518-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11039223
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: