Provider Demographics
NPI:1760088504
Name:SIMPSON-EDWARDS, DIEDREA LYNETTE
Entity Type:Individual
Prefix:
First Name:DIEDREA
Middle Name:LYNETTE
Last Name:SIMPSON-EDWARDS
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 1:1816 25TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-7744
Mailing Address - Country:US
Mailing Address - Phone:941-565-3324
Mailing Address - Fax:
Practice Address - Street 1:732 20TH LN E
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-3347
Practice Address - Country:US
Practice Address - Phone:941-666-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)