Etheldra Renee Edwards

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

9388632 Issued in FL

Practice address

16615 Vallely Dr
Tampa, FL 33618-1132

Phone

(314) 494-3469

NPI assigned

Oct 29, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Monogram Health Professional Services of Florida LLCGroup PAC ID 0244608149, 41 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: etheldra.edwards.1@22792.direct.athenahealth.com
• Direct secure messaging: etheldra.edwards.1@22854.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Monogram Health Professional Services of Florida LLC

  • Nephrology Physician
  • Jacksonville, FL
  • NPI 1538883111

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Chapters Health Palliative Care, LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Temple Terrace, FL
  • NPI 1073683553
  Medicare reassignment NPD
• Rmed LLC

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1508815358
  Medicare reassignment NPD
• Rmed LLC

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1205476793
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1942777875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16615 VALLELY DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336181132",
            "telephone_number": "314-494-3469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16615 VALLELY DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336181132",
            "telephone_number": "314-494-3469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12470 Telecom Dr Ste 300W",
            "address_purpose": "LOCATION",
            "city": "Temple Terrace",
            "state": "FL",
            "postal_code": "336370904",
            "country_code": "US",
            "telephone_number": "813-871-8183",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "ETHELDRA",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-29",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "9388632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis M Edwards, MS, LMHC
• Candace Edwards, IMH18911
• Charles Edwards, MD
• Denise K Edwards, MD
• Douglas G. Edwards, DMD
• Jesse Edwards
• Kristin Edwards, PHD
• Leetoria Edwards, ARNP
• Lenora Edwards
• Madelyne Rose Edwards

• Nurse Practitioner in Tampa, FL
• Providers in Tampa, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.