Provider Demographics
NPI:1255510632
Name:EDMOND, ANGE (CEO)
Entity type:Individual
Prefix:
First Name:ANGE
Middle Name:
Last Name:EDMOND
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593377
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32859-3377
Mailing Address - Country:US
Mailing Address - Phone:407-253-7224
Mailing Address - Fax:407-253-3783
Practice Address - Street 1:5248 SHAKAR CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1462
Practice Address - Country:US
Practice Address - Phone:407-253-7224
Practice Address - Fax:407-253-3783
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor