Provider Demographics
NPI:1982915518
Name:EDWARDS, EDITH
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 NW 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2922
Mailing Address - Country:US
Mailing Address - Phone:954-732-5693
Mailing Address - Fax:
Practice Address - Street 1:6412 N UNIVERSITY DR
Practice Address - Street 2:SUITE #114
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4055
Practice Address - Country:US
Practice Address - Phone:954-726-6722
Practice Address - Fax:954-726-6723
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 94106376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide