Healthcare Provider Details

I. General information

NPI: 1649230434
Provider Name (Legal Business Name): MELISSA K RICHARDSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-265-4801
  • Fax: 904-265-6458
Mailing address:
  • Phone: 904-483-5850
  • Fax: 904-483-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2736532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: