Provider Demographics
NPI:1518096544
Name:RICHARDS, GREGORY PAUL (ARNP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 140TH AVE N
Mailing Address - Street 2:STE 107
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3834
Mailing Address - Country:US
Mailing Address - Phone:727-524-7760
Mailing Address - Fax:727-524-7761
Practice Address - Street 1:4707 140TH AVE N
Practice Address - Street 2:STE 107
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3834
Practice Address - Country:US
Practice Address - Phone:727-524-7760
Practice Address - Fax:727-524-7761
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP166052163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0545Medicare ID - Type UnspecifiedFL MEDICARE