Provider Demographics
NPI:1023118874
Name:ALIDO, EDITH B (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:B
Last Name:ALIDO
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 W DICKENS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7514
Mailing Address - Country:US
Mailing Address - Phone:352-634-3971
Mailing Address - Fax:813-374-2495
Practice Address - Street 1:2812 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-2762
Practice Address - Country:US
Practice Address - Phone:813-374-2494
Practice Address - Fax:813-374-2495
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3390002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11813519OtherCAQH
FL308749200Medicaid
FLAL171YMedicare PIN