Provider Demographics
NPI:1861843450
Name:HOWELL, RICKY (ARNP)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:HOWELL
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 1:1039 W DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-6285
Mailing Address - Country:US
Mailing Address - Phone:904-314-5568
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 801
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6292
Practice Address - Country:US
Practice Address - Phone:904-646-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2890122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner