Healthcare Provider Details

I. General information

NPI: 1871403246
Provider Name (Legal Business Name): ROSE EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4562 OAK MOSS LOOP
MIDDLEBURG FL
32068-9063
US

IV. Provider business mailing address

4562 OAK MOSS LOOP FL 32068
MIDDLEBURG FL
32068-9063
US

V. Phone/Fax

Practice location:
  • Phone: 813-399-1433
  • Fax:
Mailing address:
  • Phone: 813-399-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: