Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 2010-00028 | NC |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME134775 | FL |
NPI | 1063620722 |
---|---|
Provider Name | Connie Edelen |
First Address | Jacksonville, FL 32257-2425 |
Second Address | Jacksonville, FL 32257-2425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/05/2019 |