Provider Demographics
NPI:1962251132
Name:RICHEMOND, PHABRINA (PMHNP)
Entity type:Individual
Prefix:DR
First Name:PHABRINA
Middle Name:
Last Name:RICHEMOND
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:DR
Other - First Name:PHABRINA
Other - Middle Name:
Other - Last Name:RICHEMOND ETIENNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:5373 NW 64TH WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2712
Mailing Address - Country:US
Mailing Address - Phone:954-338-8843
Mailing Address - Fax:
Practice Address - Street 1:525 TECHNOLOGY PARK STE 109
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7107
Practice Address - Country:US
Practice Address - Phone:407-647-2346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2024007536363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty