Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 11008429 | FL |
NPI | 1023657756 |
---|---|
Provider Name | Heather Edwards |
First Address | Punta Gorda, FL 33950-5137 |
Second Address | Fort Myers, FL 33908-3618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2019 |
Last Update Date | 29/07/2020 |