Healthcare Provider Details

I. General information

NPI: 1396873386
Provider Name (Legal Business Name): PATRICIA L EDWARDS-HARE MPH, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 6TH ST S ALL CHILDREN'S HOSPITAL
ST PETERSBURG FL
33701-4816
US

IV. Provider business mailing address

8872 134TH ST
SEMINOLE FL
33776-2635
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4315
  • Fax: 727-767-4249
Mailing address:
  • Phone: 727-398-4516
  • Fax: 727-767-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND 46
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: