Provider Demographics
NPI:1235442179
Name:ENOT FLORES, EDNA MILENA (MS)
Entity Type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:MILENA
Last Name:ENOT FLORES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:EDNA
Other - Middle Name:MILENA
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:7108 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7462
Practice Address - Country:US
Practice Address - Phone:855-832-7277
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MI6301014525103TC0700X
FL11211773103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical