Provider Demographics
NPI:1154050813
Name:NIVIOSE, EDNA
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:NIVIOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 VIA JARDIN
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7800
Mailing Address - Country:US
Mailing Address - Phone:813-777-8696
Mailing Address - Fax:
Practice Address - Street 1:1016 VIA JARDIN
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-7800
Practice Address - Country:US
Practice Address - Phone:813-777-8696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13871227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered