Healthcare Provider Details

I. General information

NPI: 1003724949
Provider Name (Legal Business Name): MARC GIDE EDMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 17TH ST
SARASOTA FL
34235-1843
US

IV. Provider business mailing address

4630 17TH ST
SARASOTA FL
34235-1843
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-5400
  • Fax: 941-487-5430
Mailing address:
  • Phone: 941-487-5400
  • Fax: 941-487-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberE343654970000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: