Healthcare Provider Details

I. General information

NPI: 1134560352
Provider Name (Legal Business Name): ALAN C EDDISON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3044 SE ORANGE TREE PL
STUART FL
34997-8518
US

IV. Provider business mailing address

3044 SE ORANGE TREE PL
STUART FL
34997-8518
US

V. Phone/Fax

Practice location:
  • Phone: 561-632-0149
  • Fax:
Mailing address:
  • Phone: 561-632-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9178001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: