Provider Demographics
NPI:1285644724
Name:SEA, TIA (ARNP)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:SEA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JANE
Other - Last Name:EDMISTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7855 ARGYLE FOREST BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5596
Mailing Address - Country:US
Mailing Address - Phone:904-594-6044
Mailing Address - Fax:904-594-6042
Practice Address - Street 1:7855 ARGYLE FOREST BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5596
Practice Address - Country:US
Practice Address - Phone:904-594-6044
Practice Address - Fax:904-594-6042
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9172987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily