Individual
EDNA PETITHOMME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 585-1111
Mailing address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 585-1111
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
APRN9322132
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN9322132
FL
Other
Enumeration date
04/09/2018
Last updated
09/20/2020
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