Healthcare Provider Details

I. General information

NPI: 1518096544
Provider Name (Legal Business Name): GREGORY PAUL RICHARDS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 140TH AVE N STE 107
CLEARWATER FL
33762-3834
US

IV. Provider business mailing address

4707 140TH AVE N STE 107
CLEARWATER FL
33762-3834
US

V. Phone/Fax

Practice location:
  • Phone: 727-524-7760
  • Fax: 727-524-7761
Mailing address:
  • Phone: 727-524-7760
  • Fax: 727-524-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberARNP166052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: