Healthcare Provider Details

I. General information

NPI: 1386817195
Provider Name (Legal Business Name): RICHARD E. PRIDAY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2008
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 SOUTH CONGRESS AVE
ATLANTIS FL
33462
US

IV. Provider business mailing address

1613 N. HARRISON PARKWAY SUITE 200, MAILSTOP SH-9A
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-7300
  • Fax: 561-967-2101
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 3405532
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3405532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: