Provider Demographics
NPI:1720287972
Name:RICHARDSON, DORIS ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32353-1000
Mailing Address - Country:US
Mailing Address - Phone:850-539-2888
Mailing Address - Fax:850-539-2766
Practice Address - Street 1:278 DR. LASALLE LEFFALL DRIVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351
Practice Address - Country:US
Practice Address - Phone:850-539-2888
Practice Address - Fax:850-539-2766
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN795271164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse