Provider Demographics
NPI:1225851504
Name:PRATT, RICHARD M III (ARNP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:PRATT
Suffix:III
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N DIXIE FWY STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6200
Mailing Address - Country:US
Mailing Address - Phone:386-423-0515
Mailing Address - Fax:386-423-0515
Practice Address - Street 1:1055 N DIXIE FWY
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6200
Practice Address - Country:US
Practice Address - Phone:386-423-0505
Practice Address - Fax:386-423-0515
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9371030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner