Provider Demographics
NPI:1619589348
Name:RICHARDS, LISA JOY (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JOY
Last Name:RICHARDS
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 1:3656 LOG CABIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34291-7083
Mailing Address - Country:US
Mailing Address - Phone:813-409-6931
Mailing Address - Fax:
Practice Address - Street 1:4578 N BISCAYNE DR
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34291-7081
Practice Address - Country:US
Practice Address - Phone:813-409-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine