Provider Demographics
NPI:1043355837
Name:EDOUARD, MIRIAM (ACNP-BC)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:EDOUARD
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W BROWARD BLVD UNIT 120881
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-8438
Mailing Address - Country:US
Mailing Address - Phone:954-608-3275
Mailing Address - Fax:
Practice Address - Street 1:400 N ASHLEY DR STE 1900
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4311
Practice Address - Country:US
Practice Address - Phone:561-445-9425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006846363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care