Provider Demographics
NPI:1063713170
Name:BERNARD, RICHARD ARTHUR JR (ARNP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ARTHUR
Last Name:BERNARD
Suffix:JR
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2827
Mailing Address - Country:US
Mailing Address - Phone:321-632-6963
Mailing Address - Fax:321-632-6983
Practice Address - Street 1:119 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2827
Practice Address - Country:US
Practice Address - Phone:321-632-6963
Practice Address - Fax:321-632-6983
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3399902363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016409800Medicaid
FL363LA2200XOtherTAXONOMY