Healthcare Provider Details

I. General information

NPI: 1730523937
Provider Name (Legal Business Name): EDITH ARNETTA FRAZIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 BRILLANTE DR
SAINT CLOUD FL
34771-8742
US

IV. Provider business mailing address

4 AMY LN
MIDDLETOWN NY
10941-2002
US

V. Phone/Fax

Practice location:
  • Phone: 845-394-1385
  • Fax:
Mailing address:
  • Phone: 845-275-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number3014471
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number9628719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: