Basic Information
| Provider Information | |||||||||
| NPI: | 1831684158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHMOND | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | ERIN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1995 E OAKLAND PARK BLVD STE 310 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333061138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669968011 | ||||||||
| FaxNumber: | 7162044337 | ||||||||
| Practice Location | |||||||||
| Address1: | 1995 E OAKLAND PARK BLVD STE 310 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333061138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669968011 | ||||||||
| FaxNumber: | 7162044337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2018 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 022155 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA9113232 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.