Provider Demographics
NPI:1184963514
Name:EDWARDS-FAGON, ANDRIA (CRNA)
Entity type:Individual
Prefix:
First Name:ANDRIA
Middle Name:
Last Name:EDWARDS-FAGON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SW 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3514
Mailing Address - Country:US
Mailing Address - Phone:954-326-1697
Mailing Address - Fax:954-326-1697
Practice Address - Street 1:920 SW 111TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-3514
Practice Address - Country:US
Practice Address - Phone:954-326-1697
Practice Address - Fax:954-326-1697
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9225237367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered