Provider Demographics
NPI:1619302650
Name:EDWARDS, ANTOINETTE V (APRN)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:V
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E. DIXIE AVENUE
Mailing Address - Street 2:REIMBURSEMENT DEPT. EDNA
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748
Mailing Address - Country:US
Mailing Address - Phone:352-323-2273
Mailing Address - Fax:
Practice Address - Street 1:1290 N RIDGE BLVD
Practice Address - Street 2:2123
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2813
Practice Address - Country:US
Practice Address - Phone:352-223-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9212908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner