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General NPI Number Information
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NPI Number | 1467265355
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Entity Type | Individual
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Provider Name | EDWARD PRINCE ETIENNE
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Gender | Male
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 3275 NW 99TH WAY
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4024
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Country | US
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Telephone | 954-357-5005
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Fax | 354-357-6533
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Provider Business Mailing Address
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Address Line | 19830 NW MIAMI CT
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City | MIAMI
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State | FL
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Zip | 33169-3361
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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