Healthcare Provider Details

I. General information

NPI: 1023889920
Provider Name (Legal Business Name): RACHEL RICCARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 N HESPERIDES ST
TAMPA FL
33614-5418
US

IV. Provider business mailing address

5706 N HESPERIDES ST
TAMPA FL
33614-5418
US

V. Phone/Fax

Practice location:
  • Phone: 813-924-4609
  • Fax:
Mailing address:
  • Phone: 813-924-4609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2849627
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: