Provider Demographics
NPI:1992076673
Name:EDWARDS, ALEXIS (AP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 INDIAN RIVER BLVD
Mailing Address - Street 2:SUITE C 136
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7126
Mailing Address - Country:US
Mailing Address - Phone:786-261-1742
Mailing Address - Fax:
Practice Address - Street 1:1575 INDIAN RIVER BLVD
Practice Address - Street 2:SUITE C 136
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7126
Practice Address - Country:US
Practice Address - Phone:786-261-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist