Provider Demographics
NPI:1992177349
Name:RICHARDSON, NIKITA M (DNP, APRN)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:DNP, APRN
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 6237
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32236-6237
Mailing Address - Country:US
Mailing Address - Phone:904-257-6882
Mailing Address - Fax:904-872-8523
Practice Address - Street 1:7855 ARGYLE FOREST BLVD STE 703
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7705
Practice Address - Country:US
Practice Address - Phone:904-257-6882
Practice Address - Fax:904-872-8523
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9279032363LF0000X
FLAPRN9279032363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily