Provider Demographics
NPI:1336192160
Name:DEBORAH MICHELLE EDWARDS
Entity Type:Organization
Organization Name:DEBORAH MICHELLE EDWARDS
Other - Org Name:GULF COAST CARDI-O-PULMONARY DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-812-5995
Mailing Address - Street 1:PO BOX 1334
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1334
Mailing Address - Country:US
Mailing Address - Phone:727-812-5995
Mailing Address - Fax:727-449-0780
Practice Address - Street 1:2016 PLAZA DELORES
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-1133
Practice Address - Country:US
Practice Address - Phone:727-812-5995
Practice Address - Fax:727-449-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6349261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6099Medicare ID - Type UnspecifiedPROVIDER NUMBER