Individual
CHRISTIAN JERRARD EDMONDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11721 MANGO GROVES BLVD, SEFFNER, FL 33584-6405
(813) 500-8919
Mailing address
11721 MANGO GROVES BLVD, SEFFNER, FL 33584-6405
(813) 500-8919
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
112858700
FL
Other
Enumeration date
02/13/2022
Last updated
02/13/2022
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