Provider Demographics
NPI:1407866635
Name:EDGSON, JENNIFER WOLF (RN, CCM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WOLF
Last Name:EDGSON
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4432 ROBIN HOOD TRL W
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2637
Mailing Address - Country:US
Mailing Address - Phone:941-377-8313
Mailing Address - Fax:941-377-0194
Practice Address - Street 1:2020 CATTLEMEN RD
Practice Address - Street 2:SUITE 600
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6283
Practice Address - Country:US
Practice Address - Phone:941-955-5191
Practice Address - Fax:941-341-4269
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9164010163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management