Healthcare Provider Details

I. General information

NPI: 1457061871
Provider Name (Legal Business Name): TKA EDWARDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2256 2ND AVE FL 2
NEW YORK NY
10029-2280
US

IV. Provider business mailing address

2256 2ND AVE FL 2
NEW YORK NY
10029-2280
US

V. Phone/Fax

Practice location:
  • Phone: 212-758-7777
  • Fax:
Mailing address:
  • Phone: 212-758-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: