Basic Information
| Provider Information | |||||||||
| NPI: | 1265687958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ROSS | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5424 GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346524008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278451736 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5424 GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346524008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278451736 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2008 | ||||||||
| LastUpdateDate: | 11/21/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9175172 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.