Provider Demographics
NPI:1275702573
Name:RICHARDSON, SYDNEY L (APRN)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24830 S TAMIAMI TRL STE 1000
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7031
Mailing Address - Country:US
Mailing Address - Phone:239-948-3280
Mailing Address - Fax:239-236-1719
Practice Address - Street 1:24830 S TAMIAMI TRL STE 1000
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7031
Practice Address - Country:US
Practice Address - Phone:239-948-3280
Practice Address - Fax:239-236-1719
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9484837363L00000X, 363L00000X
TN13229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341588OtherMEDICARE
TN1505575Medicaid