Healthcare Provider Details

I. General information

NPI: 1144945643
Provider Name (Legal Business Name): VICTORIA EDWARDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 VILLAGE OAKS DR
SAINT JOHNS FL
32259-3876
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 904-240-0442
  • Fax:
Mailing address:
  • Phone: 614-293-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116604
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.009051RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: