Provider Demographics
NPI:1578515961
Name:EDELMAN, TRESSA RAYE (FNP)
Entity Type:Individual
Prefix:MS
First Name:TRESSA
Middle Name:RAYE
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3044 OLD DENTON RD
Mailing Address - Street 2:SUITE 317
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5016
Mailing Address - Country:US
Mailing Address - Phone:972-242-4440
Mailing Address - Fax:972-242-4949
Practice Address - Street 1:3044 OLD DENTON RD
Practice Address - Street 2:SUITE 317
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5016
Practice Address - Country:US
Practice Address - Phone:972-242-4440
Practice Address - Fax:972-242-4949
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607011363L00000X, 363LF0000X
TXAP109151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6646Medicare UPIN
TXS96687Medicare UPIN
TX8G3589Medicare ID - Type Unspecified