Provider Demographics
NPI:1275777252
Name:WEXLER, EDWINA CHRISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:CHRISTINE
Last Name:WEXLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14144
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-4144
Mailing Address - Country:US
Mailing Address - Phone:727-331-7435
Mailing Address - Fax:
Practice Address - Street 1:5915 MEMORIAL HWY
Practice Address - Street 2:STE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5008
Practice Address - Country:US
Practice Address - Phone:727-331-7435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55887174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist