Provider Demographics
NPI:1598906232
Name:RICH, ETTA LAYA (ARNP-C)
Entity Type:Individual
Prefix:MS
First Name:ETTA
Middle Name:LAYA
Last Name:RICH
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 W KING ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4421
Mailing Address - Country:US
Mailing Address - Phone:407-342-8779
Mailing Address - Fax:407-843-9263
Practice Address - Street 1:120 E PAR ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-3943
Practice Address - Country:US
Practice Address - Phone:407-770-2002
Practice Address - Fax:407-770-1769
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1680082363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health