Provider Demographics
NPI:1366796948
Name:WAKELAND, RICHARD ALAN (BSN, RN, PARAMEDIC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:WAKELAND
Suffix:
Gender:M
Credentials:BSN, RN, PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10509 CYNDEE LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4801
Mailing Address - Country:US
Mailing Address - Phone:727-687-6382
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-972-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMD13459146L00000X
FLEMT69699146N00000X
FLRN9248247163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic