Healthcare Provider Details

I. General information

NPI: 1366796948
Provider Name (Legal Business Name): RICHARD ALAN WAKELAND BSN, RN, PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 05/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

IV. Provider business mailing address

10509 CYNDEE LN
ODESSA FL
33556-4801
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-7200
  • Fax:
Mailing address:
  • Phone: 727-687-6382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPMD13459
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMT69699
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9248247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: