Healthcare Provider Details

I. General information

NPI: 1235803164
Provider Name (Legal Business Name): PATIENCE MUTHEU RICHARDSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4994 INNOVATION LN
MILTON FL
32583-2551
US

IV. Provider business mailing address

4994 INNOVATION LN
MILTON FL
32583-2551
US

V. Phone/Fax

Practice location:
  • Phone: 448-432-9110
  • Fax: 448-205-2335
Mailing address:
  • Phone: 448-432-9110
  • Fax: 448-205-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11010571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: