Provider Demographics
NPI:1003269168
Name:ERICKSON, EDWARD (ARNP)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 S MIAMI AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4219
Mailing Address - Country:US
Mailing Address - Phone:305-285-2642
Mailing Address - Fax:
Practice Address - Street 1:3641 S MIAMI AVE STE 221
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4219
Practice Address - Country:US
Practice Address - Phone:305-285-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9375250363L00000X
FLARNP9375250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily