Provider Demographics
NPI:1184804726
Name:EDGE, RHONDA MARIE
Entity type:Individual
Prefix:MISS
First Name:RHONDA
Middle Name:MARIE
Last Name:EDGE
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 1:9101 E ROYAL PALM DR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-5311
Mailing Address - Country:US
Mailing Address - Phone:352-201-9083
Mailing Address - Fax:352-726-0636
Practice Address - Street 1:9101 E ROYAL PALM DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-5311
Practice Address - Country:US
Practice Address - Phone:352-201-9083
Practice Address - Fax:352-726-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services