Provider Demographics
NPI:1538778378
Name:RICHARD, HELENA SYLVIA
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:SYLVIA
Last Name:RICHARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HELENA
Other - Middle Name:SYLVIA
Other - Last Name:TAVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-243-0118
Mailing Address - Fax:850-243-0594
Practice Address - Street 1:1000 MAR WALT DRIVE
Practice Address - Street 2:WWMC INTENSIVISTS DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6708
Practice Address - Country:US
Practice Address - Phone:850-243-0118
Practice Address - Fax:850-243-0594
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008313363L00000X, 363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner