Healthcare Provider Details

I. General information

NPI: 1407866635
Provider Name (Legal Business Name): JENNIFER WOLF EDGSON R.N., C.C.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JENNIFER LYNNE WOLF

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CATTLEMEN RD SUITE 600
SARASOTA FL
34232-6283
US

IV. Provider business mailing address

4432 ROBIN HOOD TRL W
SARASOTA FL
34232-2637
US

V. Phone/Fax

Practice location:
  • Phone: 941-955-5191
  • Fax: 941-341-4269
Mailing address:
  • Phone: 941-377-8313
  • Fax: 941-377-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9164010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: