Provider Demographics
NPI:1386262210
Name:RICHARDSON, TIANNA MARTINE
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:MARTINE
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 1:5721 BENEY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-7417
Mailing Address - Country:US
Mailing Address - Phone:904-444-7440
Mailing Address - Fax:
Practice Address - Street 1:5721 BENEY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-7417
Practice Address - Country:US
Practice Address - Phone:904-444-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health