Individual
MRS. MISTY EDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRPS
Contact information
Practice address
11911 JASMINE ST, FOUNTAIN, FL 32438-2727
(850) 451-7294
Mailing address
11911 JASMINE ST, FOUNTAIN, FL 32438-2727
(850) 451-7294
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CRPS.0101304.A
FL
Other
Enumeration date
03/14/2026
Last updated
03/14/2026
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