Provider Demographics
NPI:1336645464
Name:WOLF, RICHARD A II (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:WOLF
Suffix:II
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 DREW ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3318
Mailing Address - Country:US
Mailing Address - Phone:727-461-1543
Mailing Address - Fax:727-449-0594
Practice Address - Street 1:2370 DREW ST STE B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3318
Practice Address - Country:US
Practice Address - Phone:727-461-1543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2020-06-24
Deactivation Date:2018-05-23
Deactivation Code:
Reactivation Date:2018-05-31
Provider Licenses
StateLicense IDTaxonomies
FLARNP1336645464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9425642OtherSTATE BOARD OF NURSING