Healthcare Provider Details

I. General information

NPI: 1609148121
Provider Name (Legal Business Name): RICHARD HUGH NIERLE JR. OTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8132 HUDSON AVE
HUDSON FL
34667-8571
US

IV. Provider business mailing address

7004 PARK DR
NEW PORT RICHEY FL
34652-1342
US

V. Phone/Fax

Practice location:
  • Phone: 727-863-3100
  • Fax: 727-869-7370
Mailing address:
  • Phone: 727-967-1179
  • Fax: 727-842-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberOTA 3811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: