Provider Demographics
NPI:1801549894
Name:EDMUNDSON, JOCELYN GRACE (CNA)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:GRACE
Last Name:EDMUNDSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 WALDEN OAKS PL
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-6875
Mailing Address - Country:US
Mailing Address - Phone:918-914-0895
Mailing Address - Fax:
Practice Address - Street 1:1046 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1118
Practice Address - Country:US
Practice Address - Phone:863-816-3449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL409266376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide