Provider Demographics
NPI:1649952102
Name:EDMOND, JOHN RICARDO (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RICARDO
Last Name:EDMOND
Suffix:
Gender:M
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 CARING WAY UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5300
Mailing Address - Country:US
Mailing Address - Phone:941-212-2748
Mailing Address - Fax:941-328-8946
Practice Address - Street 1:3028 CARING WAY UNIT 4
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5300
Practice Address - Country:US
Practice Address - Phone:941-212-2748
Practice Address - Fax:941-328-8946
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily