Provider Demographics
NPI:1396805594
Name:EDWARDS, CAROLINE M (APN)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:P.O. BOX 404112
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19723-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:W. JIMMIE LEEDS ROAD
Practice Address - Street 2:101 CARNIE BLVD.
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-9104
Practice Address - Country:US
Practice Address - Phone:609-652-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNO06347100363L00000X
NJNJ00084500,NO0634710363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0121894Medicaid
MD4125231Medicaid
106512ROTMedicare PIN