Individual
AMANDA RICHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5358 MONTSERRAT DR, LAKELAND, FL 33812-4083
(863) 709-3961
Mailing address
5358 MONTSERRAT DR, LAKELAND, FL 33812-4083
(863) 709-3961
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
R263012787900
FL
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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