Healthcare Provider Details

I. General information

NPI: 1790251874
Provider Name (Legal Business Name): MARY M RICHTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N ALEXANDER ST
PLANT CITY FL
33563-4303
US

IV. Provider business mailing address

4702 KEENE RD
PLANT CITY FL
33565-5428
US

V. Phone/Fax

Practice location:
  • Phone: 813-757-1200
  • Fax:
Mailing address:
  • Phone: 813-763-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number940652
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: