Provider Demographics
NPI:1679743652
Name:RICHARDS, MAUREEN M (MS, ARNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:M
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MS, ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 PICARDY COURT
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955
Mailing Address - Country:US
Mailing Address - Phone:850-240-4663
Mailing Address - Fax:903-455-4301
Practice Address - Street 1:5302 PICARDY COURT
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955
Practice Address - Country:US
Practice Address - Phone:850-240-4663
Practice Address - Fax:903-455-4301
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1325442363LF0000X, 363LP0808X
TXAP125867363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9029191OtherAETNA
FL000465400Medicaid
FLY122POtherBCBS
FL2611445OtherCIGNA
FLY122POtherBCBS