Healthcare Provider Details

I. General information

NPI: 1336854819
Provider Name (Legal Business Name): COLBIE RICHARDSON MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 NE 79TH ST
MIAMI FL
33138-4709
US

IV. Provider business mailing address

649 NE 79TH ST
MIAMI FL
33138-4709
US

V. Phone/Fax

Practice location:
  • Phone: 646-648-4005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11038805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: