Provider Demographics
NPI:1710449236
Name:BROWN RICHARDSON, MISTY TERRELL
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:TERRELL
Last Name:BROWN RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:TERRELL
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2786 TRILBY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-4985
Mailing Address - Country:US
Mailing Address - Phone:941-258-5799
Mailing Address - Fax:
Practice Address - Street 1:2786 TRILBY AVE
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-4985
Practice Address - Country:US
Practice Address - Phone:941-258-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care