Provider Demographics
NPI:1386111334
Name:RICHMOND, KIRSTIN (APRN)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 LAINDALE PL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5273
Mailing Address - Country:US
Mailing Address - Phone:813-390-4197
Mailing Address - Fax:
Practice Address - Street 1:3405 GROVE BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33567-2067
Practice Address - Country:US
Practice Address - Phone:813-390-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9497944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine