Provider Demographics
NPI:1356462006
Name:EDWARDS, JILL ELLEN (CNM)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELLEN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 LAKEWOOD RANCH BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5183
Mailing Address - Country:US
Mailing Address - Phone:941-907-9298
Mailing Address - Fax:
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5183
Practice Address - Country:US
Practice Address - Phone:941-907-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9346300367A00000X, 363LX0001X
WI5137-33367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014376400Medicaid
IB855ZMedicare PIN
IL041279552OtherRN LICENSE
IB855ZMedicare PIN