Individual
CAROL RICHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
12276 SAN JOSE BLVD, SUITE 717, JACKSONVILLE, FL 32223-8628
(904) 288-9604
Mailing address
11149 MONARCH LANDING DR, JACKSONVILLE, FL 32257-1529
(904) 710-2266
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AL1679
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL1679
LICENSE NO.
FL
Enumeration date
06/27/2006
Last updated
10/27/2009
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