Healthcare Provider Details

I. General information

NPI: 1083841571
Provider Name (Legal Business Name): HARRIETT LOUISE RICE P.A-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17192 US HIGHWAY 27
MOORE HAVEN FL
33471-5533
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 239-851-2273
  • Fax:
Mailing address:
  • Phone: 505-368-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: