Provider Demographics
NPI:1255897039
Name:PARSHALL, EDWARD JOHN (RN)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:PARSHALL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 CANDIA DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7831
Mailing Address - Country:US
Mailing Address - Phone:203-768-5775
Mailing Address - Fax:
Practice Address - Street 1:3707 CANDIA DR
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-7831
Practice Address - Country:US
Practice Address - Phone:203-768-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT066367163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty