Basic Information
Provider Information
NPI: 1003291923
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RICHARDS
FirstName: JENNIFER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5430 NW 33RD AVE
Address2: SUITE 106
City: FORT LAUDERDALE
State: FL
PostalCode: 333096349
CountryCode: US
TelephoneNumber: 9548018566
FaxNumber:  
Practice Location
Address1: 2130 NW 115TH TER
Address2:  
City: PEMBROKE PINES
State: FL
PostalCode: 330262023
CountryCode: US
TelephoneNumber: 9548018566
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/21/2015
LastUpdateDate: 06/07/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XARNP9269226FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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