Healthcare Provider Details

I. General information

NPI: 1982915518
Provider Name (Legal Business Name): EDITH EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 N UNIVERSITY DR SUITE #114
TAMARAC FL
33321-4055
US

IV. Provider business mailing address

2361 NW 63RD AVE
SUNRISE FL
33313-2922
US

V. Phone/Fax

Practice location:
  • Phone: 954-726-6722
  • Fax: 954-726-6723
Mailing address:
  • Phone: 954-732-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA 94106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: