Provider Demographics
NPI:1518189166
Name:EDWARDS, DORA ANN
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 OFFICE PLZ
Mailing Address - Street 2:116
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2778
Mailing Address - Country:US
Mailing Address - Phone:850-915-9666
Mailing Address - Fax:850-219-0338
Practice Address - Street 1:327 OFFICE PLAZA DRIVE
Practice Address - Street 2:SUITE 116
Practice Address - City:TALLLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301
Practice Address - Country:US
Practice Address - Phone:850-915-9666
Practice Address - Fax:850-219-0338
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229549372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion