Provider Demographics
NPI:1285966168
Name:RICHARDS, DONNA J (CNM)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 NW 4TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2850
Mailing Address - Country:US
Mailing Address - Phone:954-522-2979
Mailing Address - Fax:954-903-0633
Practice Address - Street 1:4101 NW 4TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2850
Practice Address - Country:US
Practice Address - Phone:954-522-2979
Practice Address - Fax:954-903-0633
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1804772163WX0003X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340169300Medicaid