Provider Demographics
NPI:1811588361
Name:RICHARDSON, JONDARIUS LAMAR (LPN)
Entity Type:Individual
Prefix:
First Name:JONDARIUS
Middle Name:LAMAR
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 CYPRESS GARDENS RD APT 96
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3905
Mailing Address - Country:US
Mailing Address - Phone:407-919-5147
Mailing Address - Fax:
Practice Address - Street 1:1510 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1976
Practice Address - Country:US
Practice Address - Phone:407-919-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5243692164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse