Provider Demographics
NPI:1295907368
Name:EDGECOMB, TAWANNA LEVONNE (CRNA)
Entity type:Individual
Prefix:
First Name:TAWANNA
Middle Name:LEVONNE
Last Name:EDGECOMB
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 1:9500 S DADELAND BLVD
Mailing Address - Street 2:802
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2824
Mailing Address - Country:US
Mailing Address - Phone:305-468-4185
Mailing Address - Fax:305-675-3378
Practice Address - Street 1:7500 SW 87TH AVE
Practice Address - Street 2:100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5426
Practice Address - Country:US
Practice Address - Phone:305-468-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-29
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3293562367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered