Provider Demographics
NPI:1740849462
Name:EDMONDSON, ANGELA RAE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RAE
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RAE
Other - Last Name:DETTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10150 HIGHLAND MANOR DR STE 205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9727
Mailing Address - Country:US
Mailing Address - Phone:813-259-1013
Mailing Address - Fax:813-254-0396
Practice Address - Street 1:10150 HIGHLAND MANOR DR STE 205
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9727
Practice Address - Country:US
Practice Address - Phone:813-259-1013
Practice Address - Fax:813-254-0396
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily