Healthcare Provider Details

I. General information

NPI: 1982512257
Provider Name (Legal Business Name): CHRISTIAN RICHARDSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 SAXON BLVD STE 207
DELTONA FL
32725-3279
US

IV. Provider business mailing address

2120 SAXON BLVD STE 207
DELTONA FL
32725-3279
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-7410
  • Fax:
Mailing address:
  • Phone: 386-917-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11050523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: