MEDICARE: VICTORIA EDWARDS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9116604	FL
2	363A00000X	Physician Assistant	50.009051RX	OH

General Provider Information

NPI Number	:	1144945643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA EDWARDS PA-C

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-5066
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 VILLAGE OAKS DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3876
Country	:	US
Telephone Number	:	904-240-0442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	01/08/2025

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Directions to “ VICTORIA EDWARDS PA-C” Practice Location

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