Provider Demographics
NPI:1699590398
Name:RICHARDSON, SEAN ROBERT (APRN)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:ROBERT
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14179 CRIMSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1613
Mailing Address - Country:US
Mailing Address - Phone:267-644-5981
Mailing Address - Fax:
Practice Address - Street 1:218 9TH STREET DR W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-4802
Practice Address - Country:US
Practice Address - Phone:941-721-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035397363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics