MEDICARE: TANIA C EDWARDS D.O.

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	207Q00000X	Family Medicine Physician	DO.917	AL
2	207Q00000X	Family Medicine Physician	053465	GA
3	207Q00000X	Family Medicine Physician	OS22812	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598768145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA C EDWARDS D.O.

Provider Business Mailing Address
First Line	:	22385 FLORA PARKE XING
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8000
Country	:	US
Telephone Number	:	904-404-8641
Fax Number	:	904-227-3246

Provider Business Practice Location Address
First Line	:	22385 FLORA PARKE XING
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-8000
Country	:	US
Telephone Number	:	904-404-8641
Fax Number	:	904-227-3246

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	10/30/2025

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