Provider Demographics
NPI:1790919348
Name:RICHARDSON, MICHELE B (ARNP,FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:B
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:ARNP,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 SW RUTLEDGE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-1978
Mailing Address - Country:US
Mailing Address - Phone:850-973-8851
Mailing Address - Fax:850-973-8365
Practice Address - Street 1:486 SW RUTLEDGE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-1978
Practice Address - Country:US
Practice Address - Phone:850-973-8851
Practice Address - Fax:850-973-8365
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2561982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily