Healthcare Provider Details
I. General information
NPI: 1528334463
Provider Name (Legal Business Name): CAROL ANN WATSON-EDGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1357 MOHEGAN TER SE
PALM BAY FL
32909-8541
US
IV. Provider business mailing address
1357 MOHEGAN TER SE
PALM BAY FL
32909-8541
US
V. Phone/Fax
- Phone: 321-537-6374
- Fax: 321-676-5206
- Phone: 321-537-6374
- Fax: 321-676-5206
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WD0400X |
| Taxonomy | Diabetes Educator Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0600X |
| Taxonomy | Gerontology Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH1000X |
| Taxonomy | Hospice Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0500X |
| Taxonomy | Infusion Therapy Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0600X |
| Taxonomy | Infection Control Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0705X |
| Taxonomy | Medical-Surgical Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0200X |
| Taxonomy | Pediatric Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WS0200X |
| Taxonomy | School Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX1500X |
| Taxonomy | Ostomy Care Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | RN2113492 |
| License Number State | FL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
