Provider Demographics
NPI:1700096922
Name:HERRAN GARCIA, EDGAR (RN, BSN, CDE, WSOC)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:HERRAN GARCIA
Suffix:
Gender:M
Credentials:RN, BSN, CDE, WSOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 TAMARACK CT APT 10
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6038
Mailing Address - Country:US
Mailing Address - Phone:787-410-0144
Mailing Address - Fax:
Practice Address - Street 1:EXT. ROOSEVELT
Practice Address - Street 2:CALLE EDDIE GRACIA 463
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-664-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZ7SRKQLJOQ163WW0000X
PR2894-A163WW0000X
PR002163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty