Christian Jerrard Edmonds
Individual provider Active NPI Developmental Disabilities Clinic/Center · Seffner, FL
NPI 1063167658 · NPPES record last updated Feb 13, 2022
Key facts
- NPI
- 1063167658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Disabilities Clinic/Center 261QD1600X
- License
- 112858700 (FL)
- Practice address
- 11721 Mango Groves Blvd
Seffner, FL 33584-6405 - Phone
- (813) 500-8919
- NPI assigned
- Feb 13, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112858700 | FL | MD | Developmental Disabilities Clinic/Center |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Disabilities Clinic/Center | 261QD1600X | 112858700 | FL | Yes |
Addresses
Primary practice location
11721 Mango Groves Blvd
Seffner, FL 33584-6405
Mailing address
11721 Mango Groves Blvd
Seffner, FL 33584-6405
Phone (813) 500-8919
Other providers in Seffner, FL
- Diverse Interventions Social and Behavioral Sciences, LLC
- Docs Hotline Inc
- Assad Migueely Duconger Guerra
- Adina Duley
- Dwic of Tampa Bay, Inc.
- Sibil Elavumkal
- Emily & Anghely'S Alf Corp
- Empower Therapeutics
- Gustavo Facio Orozco
- Jennifer Fahringer
All providers in Seffner, FL · Developmental Disabilities Clinic/Center in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.