Healthcare Provider Details

I. General information

NPI: 1982041257
Provider Name (Legal Business Name): TAI ANNETTE EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036 MILES AVE
TOLEDO OH
43606-4545
US

IV. Provider business mailing address

2036 MILES AVE
TOLEDO OH
43606-4545
US

V. Phone/Fax

Practice location:
  • Phone: 419-764-7529
  • Fax:
Mailing address:
  • Phone: 419-460-9427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number139414
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: