Healthcare Provider Details

I. General information

NPI: 1699590398
Provider Name (Legal Business Name): SEAN ROBERT RICHARDSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 9TH STREET DR W
PALMETTO FL
34221-4802
US

IV. Provider business mailing address

14179 CRIMSON AVE
BRADENTON FL
34211-1613
US

V. Phone/Fax

Practice location:
  • Phone: 941-721-3900
  • Fax:
Mailing address:
  • Phone: 267-644-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11035397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: