Provider Demographics
NPI:1881396034
Name:LAM, RICHARD (FNP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W STATE ROAD 434 STE 1010
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3817
Mailing Address - Country:US
Mailing Address - Phone:407-644-9970
Mailing Address - Fax:
Practice Address - Street 1:1400 W STATE ROAD 434 STE 1010
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3817
Practice Address - Country:US
Practice Address - Phone:407-644-9970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily