MEDICARE: MARK P. RICHARD N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	190702	MA
2	363LF0000X	Family Nurse Practitioner	APRN11012723	FL

General Provider Information

NPI Number	:	1053378646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK P. RICHARD N.P.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 TAMIAMI TRL STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-3922
Country	:	US
Telephone Number	:	941-624-2704
Fax Number	:	941-627-6066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	04/01/2024

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Directions to “ MARK P. RICHARD N.P.” Practice Location

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