Provider Demographics
NPI:1336803691
Name:RICHARDSON, CHRISTINA RENEE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RENEE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7254 180TH ST
Mailing Address - Street 2:
Mailing Address - City:LESTER PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55354-7607
Mailing Address - Country:US
Mailing Address - Phone:320-310-2462
Mailing Address - Fax:
Practice Address - Street 1:5220 BELFORT RD STE 130
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6018
Practice Address - Country:US
Practice Address - Phone:320-310-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily