Provider Demographics
NPI:1861480790
Name:EDWARDS, WILLIAM LANE JR (ARNP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LANE
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4161 TAMIAMI TRL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9204
Mailing Address - Country:US
Mailing Address - Phone:941-764-0800
Mailing Address - Fax:941-764-6494
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-764-0800
Practice Address - Fax:941-764-6494
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN768592363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302767800Medicaid
FLY48882OtherFL BC
FL302767800Medicaid