Provider Demographics
NPI:1609824028
Name:PROULX, RICHARD LAWRENCE (RN, MSN, ARNP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:PROULX
Suffix:
Gender:M
Credentials:RN, MSN, ARNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:5406 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4623
Mailing Address - Country:US
Mailing Address - Phone:954-967-8707
Mailing Address - Fax:305-575-7218
Practice Address - Street 1:1201 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1624
Practice Address - Country:US
Practice Address - Phone:305-324-4455
Practice Address - Fax:305-575-7218
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL987372363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health