Healthcare Provider Details

I. General information

NPI: 1831684158
Provider Name (Legal Business Name): DANIELLE ERIN RICHMOND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E OAKLAND PARK BLVD STE 310
FORT LAUDERDALE FL
33306-1138
US

IV. Provider business mailing address

1995 E OAKLAND PARK BLVD STE 310
FORT LAUDERDALE FL
33306-1138
US

V. Phone/Fax

Practice location:
  • Phone: 866-996-8011
  • Fax: 716-204-4337
Mailing address:
  • Phone: 866-996-8011
  • Fax: 716-204-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number022155
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: