Healthcare Provider Details

I. General information

NPI: 1306939004
Provider Name (Legal Business Name): RICHARD JOHN HANEL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 US HIGHWAY 1 S
ST AUGUSTINE FL
32086-6343
US

IV. Provider business mailing address

PO BOX 3123
SAINT AUGUSTINE FL
32085-3123
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-7058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9201530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: