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General NPI Number Information
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NPI Number | 1881377752
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Entity Type | Individual
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Provider Name | TAMARA D EDWARDS-CRUZ BUSINESS OWNER
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Gender | Female
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 2489 W 30TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-3407
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Country | US
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Telephone | 904-607-6124
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Fax |
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Provider Business Mailing Address
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Address Line | 6001 ARGYLE FOREST BLVD STE21 #153
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City | JACKSONVILLE
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State | FL
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Zip | 32244
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Country | US
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Telephone | 904-861-6686
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | E363804748750
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License Number State | FL
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