Provider Demographics
NPI:1194017509
Name:ROLAND, EDWINA INEZ (FNP)
Entity Type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:INEZ
Last Name:ROLAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:EDWINA
Other - Middle Name:INEZ
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1175 OCEAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3421
Mailing Address - Country:US
Mailing Address - Phone:228-872-2403
Mailing Address - Fax:228-872-4027
Practice Address - Street 1:1175 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3421
Practice Address - Country:US
Practice Address - Phone:228-872-2403
Practice Address - Fax:228-872-4027
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily