Provider Demographics
NPI:1568210607
Name:EDOUARD, ANNA ELIZABETH
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:ELIZABETH
Last Name:EDOUARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 RIO PINAR LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-7970
Mailing Address - Country:US
Mailing Address - Phone:786-564-8676
Mailing Address - Fax:
Practice Address - Street 1:5959 LAKE ELLENOR DR UNIT 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4633
Practice Address - Country:US
Practice Address - Phone:407-347-4958
Practice Address - Fax:407-624-5681
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-346158106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty