Provider Demographics
NPI:1093268666
Name:EDWARDS, JAIME (HIS)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9142 SHENANDOAH RUN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-5455
Mailing Address - Country:US
Mailing Address - Phone:813-782-5212
Mailing Address - Fax:813-779-4289
Practice Address - Street 1:38113 5TH AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-4973
Practice Address - Country:US
Practice Address - Phone:813-782-5212
Practice Address - Fax:813-779-4289
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5205237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist