Healthcare Provider Details

I. General information

NPI: 1710526892
Provider Name (Legal Business Name): TAVIA RICHARDS COSMETOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12414 TOUCHTON DR APT 95
TAMPA FL
33617-1544
US

IV. Provider business mailing address

3501 BESSIE COLEMAN BLVD # 22315
TAMPA FL
33630-5009
US

V. Phone/Fax

Practice location:
  • Phone: 850-420-9366
  • Fax:
Mailing address:
  • Phone: 813-452-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: