Provider Demographics
NPI:1144737438
Name:RICHMOND, ANTONIA (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E VAN FLEET DR # 313
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-3829
Mailing Address - Country:US
Mailing Address - Phone:954-990-0041
Mailing Address - Fax:
Practice Address - Street 1:115 E VAN FLEET DR # 313
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-3829
Practice Address - Country:US
Practice Address - Phone:954-990-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1744R1102XOther Service ProvidersSpecialistResearch Study
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No376G00000XNursing Service Related ProvidersNursing Home Administrator