Individual
ETHELDRA RENEE EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16615 VALLELY DR, TAMPA, FL 33618-1132
(314) 494-3469
Mailing address
16615 VALLELY DR, TAMPA, FL 33618-1132
(314) 494-3469
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9388632
FL
Other
Enumeration date
10/29/2018
Last updated
02/14/2020
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