MEDICARE: MARANDA EDWARDS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	374U00000X	Home Health Aide
2	376J00000X	Homemaker
3	372600000X	Adult Companion

General Provider Information

NPI Number	:	1821652587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARANDA EDWARDS

Provider Business Mailing Address
First Line	:	1835 W GREENWOOD ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-3911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 W GREENWOOD ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-3911
Country	:	US
Telephone Number	:	407-953-7201
Fax Number	:

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

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	04/29/2019

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Directions to “ MARANDA EDWARDS ” Practice Location

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