Provider Demographics
NPI:1518144849
Name:EDELMAN, KATHLEEN MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 STIRLING RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7126
Mailing Address - Country:US
Mailing Address - Phone:954-581-7660
Mailing Address - Fax:954-587-2075
Practice Address - Street 1:6411 STIRLING RD
Practice Address - Street 2:SUITE 220
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7126
Practice Address - Country:US
Practice Address - Phone:954-581-7660
Practice Address - Fax:954-587-2075
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2088702363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner