Provider Demographics
NPI:1245587393
Name:EDWARDS, CASEY (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:CASEY
Other - Middle Name:LEANN
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:3360 COUNTY ROAD 220
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4359
Practice Address - Country:US
Practice Address - Phone:904-291-2221
Practice Address - Fax:904-291-9192
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3394102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGN221YOtherMEDICARE
FL007142800Medicaid