Provider Demographics
NPI:1245609288
Name:RICHARDSON, ALLEGRA
Entity Type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLEGRA
Other - Middle Name:
Other - Last Name:SETTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2010 59TH ST W STE 2200
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4689
Mailing Address - Country:US
Mailing Address - Phone:941-794-5621
Mailing Address - Fax:
Practice Address - Street 1:2010 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4616
Practice Address - Country:US
Practice Address - Phone:941-794-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA911640363AS0400X
363AM0700X
FLPA11020836363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical