Provider Demographics
NPI:1164902029
Name:RICHARDSON, CIERA LESHAY (CNA)
Entity Type:Individual
Prefix:
First Name:CIERA
Middle Name:LESHAY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 MANOTAK AVE APT 2507
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1049
Mailing Address - Country:US
Mailing Address - Phone:352-875-4353
Mailing Address - Fax:
Practice Address - Street 1:1441 MANOTAK AVE APT 2507
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1049
Practice Address - Country:US
Practice Address - Phone:352-875-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA315179374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide