Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APRN11008313 | FL |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN11008313 | FL |
NPI | 1538778378 |
---|---|
Provider Name | Helena Sylvia Richard |
First Address | Fort Walton Beach, FL 32547-6707 |
Second Address | Fort Walton Beach, FL 32547-6708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2020 |
Last Update Date | 22/12/2020 |