Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME0055092 | FL |
N | 2081P2900X | Pain Medicine | ME0055092 | FL |
NPI | 1154468734 |
---|---|
Provider Name | Dr. Roxanne L Edwards |
First Address | New Smyrna Beach, FL 32168-9360 |
Second Address | New Smyrna Beach, FL 32168-9360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 16/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
063395000 | (05) | FL |
2008-00902 | STATE PROFESSIONAL LICENSE (01) | NC |