Individual
ANTAVIAN EDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2789 ORTIZ AVE, FORT MYERS, FL 33905-7806
(239) 275-3222
Mailing address
3763 EVANS AVE, FORT MYERS, FL 33901-9302
(239) 275-3222
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
FL
Other
Enumeration date
07/09/2019
Last updated
07/09/2019
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