=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073556411
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA A. EDISON ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 05/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4205 BELFORT ROAD SUITE 4020
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-1475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-450-6444
-----------------------------------------------------
Fax | 904-296-9542
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1824 KING STREET SUITE 300
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32204-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-388-1820
-----------------------------------------------------
Fax | 904-388-1827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 30317
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1940972
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------