Provider Demographics
NPI:1881026094
Name:EDWARDS, CATRINA MICHELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CATRINA
Middle Name:MICHELLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 SW 93RD LN
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-5984
Mailing Address - Country:US
Mailing Address - Phone:352-494-4249
Mailing Address - Fax:
Practice Address - Street 1:7819 NW 228TH ST
Practice Address - Street 2:
Practice Address - City:RAIFORD
Practice Address - State:FL
Practice Address - Zip Code:32026-2601
Practice Address - Country:US
Practice Address - Phone:386-431-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5166485164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse