Basic Information
| Provider Information | |||||||||
| NPI: | 1285398156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | TAJUANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 8TH AVE W | ||||||||
| Address2: | STE 101 | ||||||||
| City: | PALMETTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342214737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417764000 | ||||||||
| FaxNumber: | 9418454963 | ||||||||
| Practice Location | |||||||||
| Address1: | 4620 BARBERRY TREE CV | ||||||||
| Address2: | |||||||||
| City: | CROWLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760369582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705144846 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2021 | ||||||||
| LastUpdateDate: | 12/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 11016252 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.