Provider Demographics
NPI:1104466192
Name:RICHARDSON, ALICIA MARIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 STEVENSON DR UNIT 208
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2396
Mailing Address - Country:US
Mailing Address - Phone:321-313-7745
Mailing Address - Fax:
Practice Address - Street 1:6100 STEVENSON DR UNIT 208
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2396
Practice Address - Country:US
Practice Address - Phone:321-313-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health