Healthcare Provider Details

I. General information

NPI: 1407356199
Provider Name (Legal Business Name): RICK FERRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11929 TWILIGHT DARNER PL
RIVERVIEW FL
33569-6513
US

IV. Provider business mailing address

PO BOX 89356
TAMPA FL
33689-0405
US

V. Phone/Fax

Practice location:
  • Phone: 813-609-0219
  • Fax: 888-979-6989
Mailing address:
  • Phone: 813-609-0219
  • Fax: 888-979-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: