Healthcare Provider Details

I. General information

NPI: 1144410713
Provider Name (Legal Business Name): KARISSA LEIGH RICHARDS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 SE WILLOUGHBY BLVD
STUART FL
34994-5059
US

IV. Provider business mailing address

3511 SE WILLOUGHBY BLVD
STUART FL
34994-5059
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-7789
  • Fax: 772-221-8584
Mailing address:
  • Phone: 772-221-7789
  • Fax: 772-221-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberANT9251384
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberANT9251384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: