Provider Demographics
NPI:1689445132
Name:PARKER, EDITH MARIE
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:MARIE
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5379 N PRINCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-2425
Mailing Address - Country:US
Mailing Address - Phone:135-223-3959
Mailing Address - Fax:
Practice Address - Street 1:5379 N PRINCEWOOD DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-2425
Practice Address - Country:US
Practice Address - Phone:352-223-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP626213706240347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle