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General NPI Number Information
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NPI Number | 1558398289
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Entity Type | Individual
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Provider Name | CAROL RICHARDS ATC
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 12276 SAN JOSE BLVD SUITE 717
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8628
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Country | US
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Telephone | 904-288-9604
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Fax |
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Provider Business Mailing Address
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Address Line | 11149 MONARCH LANDING DR
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City | JACKSONVILLE
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State | FL
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Zip | 32257-1529
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Country | US
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Telephone | 904-710-2266
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | AL1679
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License Number State | FL
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