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General NPI Number Information
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NPI Number | 1457853038
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Entity Type | Individual
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Provider Name | RICHARD PETCH ARNP
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Gender | Male
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 3871 E HIGHWAY 98 STE 203
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City | PORT ST JOE
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State | FL
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Zip | 32456-5302
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Country | US
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Telephone | 850-229-5661
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2699
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City | PENSACOLA
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State | FL
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Zip | 32513-2699
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Country | US
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Telephone | 850-475-4500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9309634
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License Number State | FL
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